![]() You have 12 months from the date of service to resolve your claim, if you originally submitted the claim within 90 days from the date of service. If you had to bill another insurance carrier before billing MassHealth, you have 90 days from the date of the explanation of benefits (EOB) of the primary insurer to submit your claim.įinal submission deadline. Initial claims must be received by MassHealth within 90 days of the service date. Usual turnaround time for Medicare/MassHealth crossover claims forwarded to MassHealth by the Massachusetts Medicare fiscal agent to be processed. For information on prior approval, claims submission, and claims status please visit Beacon Health Options.Average time for both electronic (EDI) and paper claims to process on a remittance advice (RA). Lancaster, NY 14086 Behavioral Health Services Claimsīehavioral Health Services for HCP DIRECT EmblemHealth members are managed by Beacon Health Options. Physical and Occupational Therapy claims for all HCP DIRECT EmblemHealth members are handled by Palladian Physical and Occupational Therapy. You must file the appeal within 60 calendar days from the date of this explanation of payment. Out-of-Network Providers Submitting Medicare Advantage Claimsįor claims denials that resulted in partial or zero payment: You are only permitted to file a standard appeal for a denied Medicare Advantage claim if you complete a Waiver of Liability, which states that you will not bill the member regardless of the outcome of the appeal. Completed forms can be faxed to (516) 394-5693. Please download the Claims Reconsideration Request Form and follow the instructions. Claim ReconsiderationĪs a participating HCP provider, you may request Claim Reconsideration for any claim submission that you feel was not properly processed. Login credentials for EZ-Net are required. Use EZ-Net, HCPs secure web-based data exchange application, to view the status of an existing claim previously submitted to HCP. Where HCP is the secondary payor under Coordination of Benefits, the time period shall commence once the primary payor has paid or denied the claim. The timely filing for Medicaid, Medicare, and Commercial claims is within 120 days of the date of service. Highlighted areas can become fully obscured during the scanning process. All paper documents are scanned using light-sensitive equipment. Do not use colored highlighters on your claim forms.Failure to submit the most specific ICD-10 code(s) may result in the rejection of your claim. The Centers for Medicare and Medicaid Services (CMS) requires that ICD-10 codes be submitted at the highest level of specificity.Always include your Tax ID Number and NPI (National Provider Identification) number.Any missing or omitted information may lead to a delay in processing or rejection of your claim. Be sure to properly complete your claim form.Garden City, NY 11530 Helpful Tips for Successful Paper Claim Submission ALL HCP Direct paper claims must be faxed to (516) 515-8870 or mailed to: Retain copies of your EDI transmission acceptance reports as evidence of transmission.Īll paper claims for HCP Direct members must be submitted on a properly completed CMS 1500 or UB04 claim form.Mismatched patient information may result in the rejection of your claim. Verify that the Member’s first and last names, health plan ID, and date of birth match current eligibility records. ![]()
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