Providers who call Customer Service to
question claim payments or to request a claim adjustment will now be directed
to submit the request via the NaviNet web portal. This requirement includes
those contracted with Magellan Behavioral Health, Inc. for PPO business.
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.
To access the Claim INFO Adjustment
Submission transaction, select Claim Inquiry and
Maintenance from the Plan Transactions menu. 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.
Detailed user guides for both of these
transactions are available on our Plan Central page under Administrative Tools
& Resources.
Note:
Your office location was required to register for NaviNet by April 1,
2013. If you have not yet done so, 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.