The EOP/RA for each claim, if wholly or partially denied or contested, includes an explanation of why Health Net made its determination. Los Angeles, CA 90074-6527. Inpatient professional claims must include admit and discharge dates of hospitalization. You can now submit claims through our online portal. The OPP can explain your rights, and may be able to help resolve your complaint or grievance. BMC HealthNet Plan is a non-profit managed care organization that has provided health insurance coverage to Massachusetts residents for more than 20 years. Helpful Links Enroll in a Plan Healthy Living Resources Senior Care Options FAQs About Us Careers News Contact Us I Am A. Submission of Provider Disputes Date of receipt is the business day when a claim is first delivered, electronically or physically, to Health Net's designated address for submission of the claim depending upon the line of business (see Submission of Claims section). These claims will not be returned to the provider. timely filing limit denials; wrong procedure code; How to Request a Claim Review. Log into our provider portal to check member eligibility. Statement from and through dates for inpatient. Patient or subscriber medical release signature/authorization. Procedure Coding Get to healthy with a little more help. Please do not hand-write in a new diagnosis, procedure code, modifier, etc. Billing provider tax identification number (TIN), address and phone number. Appropriate type of insurance coverage (box 1 of the CMS-1500). The National Uniform Billing Committee's UB-04 Data Specifications Manual is available here. It provides additional member extras beyond the state's required coverage, including: for MassHealth members, free car seats, bike helmets and manual breast pumps for nursing mothers; for ConnectorCare members, discounts on Weight Watchers and fitness club memberships; for Senior Care Options members a healthy rewards card, enhanced vision benefit and a fitness reimbursement. Providers billing for institutional services must complete the CMS-1450 (UB-04) form. Our behavioral health partner, Beacon Health Strategies, developed a series of tools and resources for medical providers regarding geriatric depression. Health Net recommends that self-funded plans adopt the same time period as noted above. If we reject a claim for a missing NPI number, you must submit it as a new claim with updated information. If Health Net identifies an overpayment due to a processing error, coordination of benefits, subrogation, member eligibility, or other reasons, a notice is sent that includes the following: Failure to comply with timely filing guidelines when overpayment situations are the result of another carrier being responsible does not release the provider from liability. A free version of Adobe's PDF Reader is available here. Please submit a: Health Net Claims Submissions | Health Net This will allow the use of built-in functions that are not consistently available when the PDF opens in Windows Explorer or Edge, Google Chrome, Mozilla Firefox, or Apple's Safari. Claims Refunds Providers can submit claims electronically directly to WellSense through our online portal or via a third party. CPT is a numeric coding system maintained by the AMA. Contact the applicable Health Net Provider Services Center at: Appropriate type of insurance coverage (box 1 of the CMS-1500). If your prior authorization is denied, you or the member may request a member appeal. ^Au25 #['!adc}KGc=\qNVlqDg`HRZs. Enrollment in Health Net depends on contract renewal. *If you require training or assistance with our online portal, please contact your dedicated provider Relations Consultant. The following review types can be submitted electronically: Once you complete and submit the online Request for Claim Review, you will receive a confirmation screen to confirm that your request was submitted successfully. P.O. Sending requests via certified mail does not expedite processing and may cause additional delay. Nonparticipating provider claim payment disputes also include instances where you disagree with the decision to pay for a different service or level than billed. Modifier GQ will need to be added when billing for phone/telephonic services in addition to the HCPC & modifier combination identified below. Did you receive an email about needing to enroll with MassHealth? Share of cost is submitted in Value Code field with qualifier 23, if applicable. Diagnosis pointers are required on professional claims and up to four can be accepted per service line.
