As previously communicated, in 2011 we introduced our provider self-service
initiative, which requires providers to use our automated tools for member
eligibility and claim status inquiries. We are now expanding the provider
self-service requirements to include questioning of claim payments or to
request a claim adjustment. This requirement is already in place for primary
care physicians who participate in the Quality Incentive Payment System (QIPS)
program and will apply to all participating providers, including those
contracted with Magellan Behavioral Health, Inc. for PPO business.
Effective May 1, 2013, providers who call Customer Service to question claim
payments or to request a claim adjustment will be directed to submit the
request via the NaviNet web portal. NaviNet offers the Claim INFO Adjustment
transactions to ensure that your claim adjustment requests are addressed in the
most efficient manner available.
[
]Using the Claim INFO Adjustment Submission
transaction[
]
The Claim INFO Adjustment Submission transaction allows ancillary, facility,
and professional providers to submit adjustment requests or question claim
payments for paid or denied claims for a period of up to 18 months after
adjudication of the original claim or as required by applicable law. Each
submission is assigned a unique adjustment identification (ID) number.
You can access IBC?s response within ten business days through the Claim INFO
Adjustment Inquiry transaction. If you do not receive a response within ten
business days of the submission, please call Customer Service and have your
adjustment ID number available.
To access the Claim INFO Adjustment Submission transaction, select Claim
Inquiry and Maintenance from the Plan Transactions menu. Detailed user guides
for these transactions are available on our Plan Central page under
Administrative Tools & Resources.
Your office location was required to register for NaviNet by April 1, 2013. If
you have not done so, please visit [
]NaviNet[] and select Sign Up from the top right. If your office is
currently NaviNet-enabled, but would like training on how to submit a claim
adjustment or retrieve a response to a submitted request through NaviNet,
please contact our eBusiness Provider Hotline at [
]215-640-7410[].
[
]Magellan Behavioral Health, Inc., an independent
company, manages mental health and substance abuse benefits for most IBC
members.[
]
NaviNet? is a registered trademark of NaviNet,
Inc., an independent company.