However, if a provider wishes to request a prior authorization by mail or fax using a form, it must be this form as prescribed by the Texas Department of Insurance. Participating physicians, professional providers, ancillary and facility providers may not seek payment from the member for claims submitted after the 95-day filing deadline. <> EFT is a direct deposit claim payment from BCBSTX to your designated bank account. This date is based on the date of the other carriers decision. Yes. This new site may be offered by a vendor or an independent third party. This new site may be offered by a vendor or an independent third party. P.O. Fax: 713-663-1227 Most people don't view their physical and mental health as separate, and neither do we. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas El Paso, TX 79912 -6156 BCBS Prefix List. Blue Medicare HMO Blue Medicare PPO Contact: 1-888-296-9790 or. Medicare Plus Blue SM PPO claims Blue Cross Blue Shield of Michigan P.O. Mailing address: 5660 University Parkway. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. You can download the toolkithere. (See item #2 below to learn how to contact your BCBS company to address any errors.) No. Click the link below to find the provider portal for your needs. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Texas - Claims PO Box 660044 Dallas, TX 75266-0044 How to submit an international claim You can submit your completed international claim form and documentation using one of the following methods: By mail: Service Center P.O. Claims Courier is an 837P compliant application. The following address should be used for claims related to outer counties: Outer County Claims - Lehigh, Lancaster, Northampton, and Berks County Claims Receipt Center P.O. Contact Magellan Health Services or call 1-800-788-4005 For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390 Effective 6/27/2022, a Behavioral Health Service Coordination can help members manage complex conditions related to mental health and substance use. [Maryland and WDC] Offers healthcare insurance to residents of Maryland and Washington, DC. Availity EFT & ERA Enrollment User Guide. Horizon Behavioral Health. Contact us By mail. Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044. This is the customer service number for questions about your health insurance coverage, benefits or treatment. Contact Availity or other electronic connectivity vendor or call 1-800-451-0287*, *interactive voice response (IVR) system to access, you must have full member's information (for example, member's ID, patients date of birth, etc. This practice is called balance billing and is not permitted. As a Magellan network provider, what is my timely filing limit?A. Instructions for submitting requests for predetermination Click to skip to content. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. endobj Together, we're committed to making a meaningful difference in the health of all Floridians. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR), CHIP, and STAR Kids members. Users will obtain immediate feedback regarding the results of the test to ensure compliance with HIPAA rules and codes. From 2015 to 2017, our programs contributed to a 26% increase in members who were asked by their behavioral health providers to authorize communication with their PCP providers.3, Working with HealthConnections, the team helped get me to a place of not having fear, not having pain, exercising and doing yoga. Effective 6/27/2022, a Behavioral Health Service Coordination can help members manage complex conditions related to mental health and substance use. Fax: 361-852-0624 For exceptions to the standard timely filing requirements for specific states and/or plans/programs, refer to your contract withMagellan and/or its affiliates; see theMagellan state-, plan-and EAP-specific handbook supplements; refer to our timely filingexception grid; or consult state and federal laws. . Main telephone number 1-215-937-8000. Box 660044 P. O. As a result of this determination, remittance advice, known as an Explanation of Payment (EOP) is sent to you. 800-637-0171, press 3 2615 Calder St, Suite 700 The 60-day inpatient readmission rate in Pennsylvania was nearly cut in half, from 21% to 11%, for members utilizing MAT at discharge versus those who were not.2. The State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) Program: 1-800-991-5579. TennCare Pharmacy Program 1-888-816-1680. Join our extensive provider network today! These members enjoy the same level of coverage as other Medicare Advantage members with no network restrictions. Health Coaching and Interventions: 1-800-672-7897 (toll free) Blue Cross and Blue Shield of North Carolina P.O. Contact Information. EAP providers can request an EAP authorization by leaving a brief voicemail message. External link You are leaving this website/app (site). Dallas, TX 75266-0027, Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members, Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-451-0287*, Behavioral health services mental health and chemical dependency, For prior authorization and referrals managed by BCBSTX: (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services). PDF File is in portable document format (PDF). Preauthorization requirementsfor Blue Cross and Blue Shield of Texas commercial plans(PDF), Magellan'sannual preauthorization reportfor BCBSTX commercial plans (PDF), Provider bulletin regarding Texas HB 3041 (PDF). Claims are paid based on your status on the date of service. Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management. Through increased access to evidence-based treatment options and effective preventive measures, we are making it easier for members to recover and stay out of hospitals. %PDF-1.5 % If you need to mail claims: Horizon BCBSNJ. Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Interested in exploring opportunities? 4444 Corona, Suite 148 If after reviewing your rates you still believe there is an error, please contact the toll-free number on the member's ID card or the Members Explanation of Benefits, or call your Magellan network representative. It is important that you review all EOPs promptly. Tricare Phone Number and Claim Address. What is the appeals process? and the amount . . The process typically takes about 3 to 4 weeks to complete the process, so allow ample time to complete your independent testing. Q. 9~zfH. View the 2021 GuideWell Social Impact Report. Predetermination form and Keystone First 200 Stevens Drive Philadelphia, PA 19113. Contact Magellan Healthcare. Box 2048 Southeastern, PA 19399 Online: at www.bcbsglobalcore.com Magellan recommends Claims Courier for low volume claim submitters who dont want to use a clearinghouse. Utilization Management (Prior Authorizations), STAR Kids Referral and Authorization Process, Value-Added Services for STAR, CHIP and STAR Kids, Quality Improvements (QI) Toolkits and Tip Sheets, Home Delivery Pharmacy (Mail-Order Pharmacy), Medicaid (STAR) and CHIP Prior Authorization Forms, National Uniform Claim Committee (NUCC) 1500 Health Insurance Claim Form Reference Instruction Manual, Independent Review Organization (IRO) and EMR Provider Training, Interpreting the PLB Segment on the 835 ERA Guide. Copyright 2022Health Care Service Corporation. 1-800-637-0171, press 3 or 1-713-663-1149 Our innovative care coordination, case and utilization management programs, and vast network of behavioral health and specialty providers facilitate improved access to cost-effective and quality care while improving quality of life for the members we serve. Fax: 1-800-424-5881. The toolkit includes coverage and reimbursement options for postpartum depression through Medicaid, CHIP, the Healthy Texas Women Program, the Family Planning Program and other referral options. Resubmission of Claims: Claims that must be revised and resubmitted after adjudication must be stamped resubmission or otherwise noted on box 22 of the CMS-1500 form. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas Box 91059 Seattle, WA 98111-9159 *Washington Regence Blue Shield P. O. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. Paper Pharmacy Claims: Send to: Attention Paper Claims Processing. Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. Dallas, TX 75266-0044, Behavioral health services - claims status inquiries, For services managed by BCBSTX: Appeals Provider Manual June 2021 15.5 15 Requesting an appeal For all Part C and Part D standard appeals, the Member or his or her authorized representative should mail the written appeal to: Keystone 65 HMO/Personal Choice 65 PPO Member Appeals Department Claims Submission. For the most recent information available in Pennsylvania including vaccine details, go to the, Claims/ Check Eligibility/ View Authorizations, You are on primary menu. Where do I send the claim information?A. Join Blue Cross and Blue Shield companies and leading voices from NAMI, Business Group on Health and Morgan, Lewis & Bockius LLP as they come together to discuss strategies for addressing pandemic-amplified behavioral health challengesparticularly as vaccines are rolling out and more focus on hybrid work models are set to spur workplace changes that can impact employee behavioral health. The EPSarrives fasterthan the PCS andis easier to archivefor future retrieval. Because claims mailing addresses are different for different Blue Plan members, using the Claims Routing Tool is the most accurate way to determine a claims mailing address. Call 911. Richmond, VA 23242 Email to submit provider inquiries, 1001 E. Lookout Drive Magellan Behavioral Health Providers of Texas, Inc. Request for claim review form and instructions, Wellness and clinical practice guidelines, Independent Diagnostic Testing Facility (IDTF), Intensive Outpatient facility programs (PHP/IOPs). Fax: 512-349-4853 Magellan is committed to the fight against the opioid epidemic and other substance use disorders (SUDs) affecting far too many of our family members and friends. Claim status inquiries (out-of-state subscribers) contact Availity or other electronic connectivity vendor. For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. 1-800-729-2422: Behavioral health services - claims status inquiries. Through this option, providers submit an 837 file to a third party middle-man who in turn submits the files to Magellan. As a Magellan provider, you are required to hold HealthChoices members harmless and cannot bill them for the difference between your contracted rate with Magellan and your standard rate. Fax: 972-766-2231 Box 7026 Wheeling, WV 26003 Wisconsin Anthem Blue Cross Blue Shield Go directly to an emergency room. Blue Cross and Blue Shield of Illinois 300 East Randolph Street Chicago, Illinois 60601-5099. Care Management Contact Information . PO Box 660044 Dallas, TX 75266-0044 Fax: (325) 794-2926 Claims, medical and mental health: Send Claims Form to: Blue Cross and Blue Shield of Texas PO Box 660044 Dallas, TX 75266-0044 Learn more about submitting claims. Do the timely filing limits apply to this claim?A. What should I do? Most PDF readers are a free download. If your state has multiple brands (WA, CA, OR, NY, NJ, to name just a few) then you'll want to ask for the exact address to file to. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. BCBS Prefix List AAA to AZZ. Fax to: 1-888-579-7935 Birmingham, Alabama 35244-2858. If you are enrolled in a Lowe's medical plan with BCBS AL, you will contact Magellan Health for services (1-877-543-3875, press 2, then press 1). Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. . Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Copy of an EOP with a date within the timely filing period, Certified or overnight mail receipts dated within the timely filing period, Copy of the claim with Magellan's date stamp within the timely filing period, Copy of 2nd level EDI 277 acceptance reports. Resubmissions must be submitted within 60 days from the date of denial. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. You are leaving this website/app (site). All Rights Reserved. % Claim forms must be submitted to: Blue Cross and Blue Shield of Alabama. If this is an emergency situation, do one of the following: Call 911, go directly to an emergency room, or call your doctor or therapist for help. You will be assigned an IT analyst to guide you through the process and address any questions. Eligibility and benefits Blue Shield Initial Appeal Resolution Office Attn: Hospital Exception and Transplant Team P.O. What should I do? Email to submit provider inquiries and questions, North Texas Dallas, Fort Worth, East Texas (ExcludesBastrop, Bell, Bosque, Burleson, Burnett, Caldwell, Falls, Fayette, Hays, Hill, Lee, Leon, Limestone, Madison, Milam, McLennan, Robertson, Travis, Wichita and Williamson counties), Blue Cross and Blue Shield of Texas All claims for covered services provided to HealthChoices Members must be submitted to and received by Magellan as follows: Within sixty (60) days from date of service for most levels of care except as provided below; Within sixty (60) days from date of discharge for 24/hr level of care; Within sixty (60) days of the last day of the month or the discharge date, whichever is earlier when billing monthly for longer treatment episodes of care at a 24/hr level facility; Within sixty (60) days of the claim settlement for third party claims. About 3 to 4 weeks to complete the process, so allow ample time to complete independent... T view their physical and mental health as separate, and if applicable Medicare... Leaving this website/app ( site ) http: //access.adobe.com can request an eap authorization by leaving brief. Blue Medicare HMO Blue Medicare HMO Blue Medicare PPO contact: 1-888-296-9790.. Pcs andis easier to archivefor future retrieval making a meaningful difference in the health of all.... Bcbs Prefix List -6156 BCBS Prefix List network restrictions applicable, Medicare Numbers for your when! Related to mental health and substance use level of coverage as other Medicare Advantage with. Your independent testing number for questions about your health insurance coverage, benefits or treatment future retrieval with no restrictions. Learn how to contact your BCBS company to address any errors. contacting network Management Texas El,. Forms must be submitted to: Attention paper claims Processing and Blue Shield of North Carolina.! Contact your BCBS company to address any questions or other electronic connectivity vendor health Coaching and Interventions 1-800-672-7897. Do the timely filing limit? a is an Association of 35 independent, locally operated Blue Blue... Skip to content you need to find the provider portal for your needs limits to... Medicare-Allowed amount less any member cost-sharing balance billing and is not permitted be assigned an it to. Below to learn how to contact your BCBS company to address any.. Of 35 independent, locally operated Blue Cross Blue Shield Go directly to an room. Submits the files to Magellan provider inquiries and questions, Blue Cross and Blue Shield of Texas El Paso TX! Instructions for submitting requests for predetermination click to skip to content Pharmacy claims: Horizon BCBSNJ, as! 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