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NaviNet® Claim INFO Adjustment requirement

March 1, 2013

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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 payment 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 for Behavioral Health, Inc. PPO business.

Effective May 1, 2013, providers who call Customer Service to question claim payment 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 your claim adjustment requests are addressed in the most efficient manner available.

The Claim INFO Adjustment Submission transaction allows ancillary, facility, and professional providers to submit adjustment requests or question claim payment 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 will be able to access IBC?s response within ten business days through the Claim INFO Adjustment Inquiry transaction. You may call Customer Service if you do not receive a response within ten business days of the submission. Please have your adjustment ID number available as this information will be required when you call.

To access the Claim INFO Adjustment Submission transaction, select Claim Inquiry and Maintenance from the Plan Transactions menu. Detailed user guides for this transaction are available on our Plan Central page under Administrative Tools & Resources.

If your office location is not yet registered for NaviNet, you must do so by April 1, 2013. To register, 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.

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