Electronic Claims and Transactions - EAP Services Application
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Electronic Claims & Transactions
This webpage provides numerous tools and resources to assist you in preparing to send to and receive electronic communication from Magellan.
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Submitting Transactions and Claims
Please evaluate and take advantage of one of the electronic methods available to you for submitting your claims quickly and easily. Save time and eliminate paperwork by taking advantage of one of these three options:
Claims Courier
Direct Submit
Clearinghouses
Claims Courier
Accessible via this Magellan provider website, Claims Courier is a Web-based data entry application for providers submitting professional claims on a claim-at-a-time basis. You can gain access to Claims Courier by signing onto the site with your username and password, and following the instructions for “Submit a Claim Online.” Claims Courier streamlines the claims process by eliminating the claims middleman, and there is no charge to you for using the service. You simply data enter your claims information into the online Claims Courier application. Note that Magellan must be the designated payer in order to process your submitted claims.
On the main Claims Courier (Submit a Claim) page, you can:
- Create a new, blank claim
- Create a new claim from a copy of a previously submitted claim
- Complete a claim you saved previously
- View your submitted claims.
Direct Submit
Through this Magellan application, HIPAA-compliant 837 files can be sent directly to Magellan in bulk, without accompanying claim data entry or the involvement of a clearinghouse. Direct Submit is available to all providers regardless of claims submission volume. There is no charge to you for using the service.
To get started on the process, visit our EDI Testing Center website at www.edi.MagellanProvider.com. The center offers an easy-to-follow, six-step process to independently validate your EDI test files (837 Professional and Institutional) for HIPAA compliance rules and codes. You will be assigned an IT analyst to guide you through the process and address any questions. The process includes creating your unique user ID and password, downloading EDI guideline documentation (companion guides), uploading and testing EDI files, and obtaining immediate feedback regarding the results of the validation test. Once you have completed the six-step process, you will be able to exchange production-ready EDI files with Magellan.
You can register to submit EDI claims to Magellan by sending an email to EDISupport@MagellanHealth.com or by contacting Magellan EDI Support at 1-800-450-7281, extension 70536.
You’re there for your patients. We're here for you.
Audit Tools
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Joining our Network
- Professional Provider Selection Criteria
- Credentialing Process
- Network Provider Agreement Exhibits
- EAP Department of Transportation Substance Use Professionals
- Military & Family Life Counseling Program
- Veterans Disability
Clearinghouses
Electronic Remittance Advice Form for clearinghouses (PDF)
Direct Deposit
With electronic funds transfer (EFT), payments are securely deposited directly into your bank account. Magellan network providers must enroll in EFT.* EFT is available to providers who own the Taxpayer Identification Number (TIN) linked to the submitted claim. To learn how to enroll in EFT, select the link for the members you serve:
- Employee Assistance Program
- Pennsylvania HealthChoices
- All other plans (ECHO Health)
If you serve members in more than one category, you must enroll via each method to receive all of your payments through EFT.
*Currently, this requirement does not apply to EAP payments or Pennsylvania HealthChoices claims.
You’re there for your patients. We're here for you.
Companion Guides
he Magellan Companion Guides provide detailed instructions on exchanging HIPAA compliant ASC X12N transactions with Magellan. The documents are designed for the technical departments or areas responsible for submitting electronic transactions to Magellan. However, the business rules within these guides are to be communicated to and coordinated with the appropriate departments responsible for the capture or generation of any data required in the HIPAA standard transactions.
Magellan Standard Companion Guides include information regarding:
- Working with Magellan
- Connectivity
- Contact information
- Control segments
- Magellan business rules
- Acknowledgments
- Testing
The transaction-specific Companion Guides (click on the Public Resources tab at www.edi.MagellanProvider.com) include Magellan's business rules specific to the individual type of transaction.
You’re there for your patients. We're here for you.
National Provider Identifier
Magellan requires providers to submit their National Provider Identifier (NPI) on all HIPAA-standard electronic transactions. All standard electronic transactions received without NPIs will be rejected. NPI numbers replace all government-issued identifiers, Medicaid PINs and Medicare UPINs (as well as Magellan-assigned MIS numbers) on HIPAA-standard electronic transactions, including provider claims submitted electronically. Taxpayer Identification Numbers (TINs) continue to be required on all claims – both paper and electronic.