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Frequently Asked Questions: Electronic Claims Submission

Q. Does Magellan accept electronic claims submission? 
A. Yes, Magellan strongly encourages electronic claims submissions for services normally submitted on a Form CMS-1500 and for institutional claims normally submitted on a UB-04.

Q. What are the benefits of electronic claims filing? 
A. Electronic claims filing allows for earlier detection of errors and drastically reduces the likelihood of claims being rejected or denied for payment and, more often than not, will result in faster processing. In addition, submitting electronically reduces postage and other paper related expenses and supports improvement to your overall efficiency.

Q. How can I submit electronic claims to Magellan? 
A. Magellan providers have three convenient options for submitting electronic claims:

  1. Claims Courier
  2. Direct Submit
  3. Clearinghouses

Please refer to the Electronic Claims Submission page for more information.

Q. Will I be charged a fee to submit my claims electronically? 
A. Magellan will not charge a fee for electronic claims submitted through our Claims Courier or Direct Submit options. However, our contracted clearinghouses do charge fees based on your ability to submit a HIPAA-compliant (X12) transaction. The fees charged by these clearinghouses are in addition to fees Magellan absorbs for each EDI transaction.

Q. Will Magellan continue to accept paper claims? 
A. While paper claims are still accepted in most regions, we recommend providers switch to electronic claims submission.

Q. Are there HIPAA-compliant billing code requirements for electronic claims submissions? 
A. Yes. All electronic claims submissions must include HIPAA-compliant billing codes to be processed.

Q. What if I already use a clearinghouse and it’s not the same as the clearinghouses that Magellan is using? 
A. To submit electronic claims to Magellan, your clearinghouse needs to contact one of the Magellan clearinghouses to arrange transmission of the claims.

Q. Can a practice of any size file electronic claims? 
A. Yes.

Q. Can claims be filed electronically for all Magellan lines of business? 
A. Most claims for which Magellan is the payor can be received electronically.

Q. What should I do if my claim is rejected for payment? 
A. Be sure to thoroughly read any reject notices you receive. If you have questions after reading the reject notice, call Magellan for further clarification. Often the same error is submitted repeatedly resulting in repeated rejections. After reviewing the rejection notice, the claim should be corrected and re-submitted. If you use a clearinghouse, it is critical that you read the reject reports from the clearinghouse and work with the clearinghouse to resolve.

Q. What should I do if I receive a notice that my claim was accepted, but then don’t receive payment? 
A. If you receive a notice that Magellan accepted your claim, you can check the status of your claim through the Claims Inquiry application after securely logging on to the Magellan provider website.

Do not re-submit the claim as this will result in a claim denied as a duplicate, and you may be subject to unnecessary clearinghouse charges.