Claims are paid based on your status on the date of service. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?Ī. I recently joined the Magellan provider network. Does this timely filing limit apply to all claims for all members (e.g., COB, Medicare, etc.)?Ī. For this reason, your resubmitted claim has been denied. Magellan did not receive your resubmitted claim within our timely filing limits (or within the timely filing limits of your state) after the initial date of denial. This claim is a resubmit why was it denied for timely filing?Ī. Enforcing this clause also brings us in line with industry practices. By enforcing the timely filing requirement in the provider contract, we are able to focus our resources on what our providers have asked us to do - promptly pay claims. Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. I have never had a claim denied for timely filing reasons before why is it being denied now?Ī. ![]() It is important for you to stay current with your specific state and/or plan/program requirements. Please note: as these requirements can be subject to change, the grid may not contain a complete list of exceptions. If claims are submitted after the timely filing limit, they will be denied for payment, subject to applicable state and federal laws.įor exceptions to the standard timely filing requirements for specific states and/or plans/programs, refer to your contract with Magellan and/or its affiliates see the Magellan state-, plan- and EAP-specific handbook supplements refer to our timely filing exception grid or consult state and federal laws. This means that, subject to applicable state or federal laws, claims must be submitted to Magellan within 60 days of the date of service or inpatient discharge. Under Magellan's policies and procedures, the standard timely filing limit is 60 days. As a Magellan network provider, what is my timely filing limit?Ī. If physicians have questions about the CMS Clinical Eligibility Attestation, please contact a CMS plan nurse at 1-85.Q. Please be sure to submit all five pages of the attestation. Completed and signed attestations can be submitted by the physician to the Department of Health via secure email at or via fax to 85. If you are the treating physician of a child and you would like to attest to the eligibility of your patient for the CMS plan, please review the CMS Clinical Eligibility Attestation for Physicians and a list of qualifying chronic and serious conditions. This plan is offered by the Florida Department of Health who has contracted with WellCare of Florida, Inc to provide managed care services to our members. Each COVID-19 related exceptional claim requires this specific COVID-19 cover sheet.Ĭhildren’s Medical Services Health Plan (CMS Health Plan) is a Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Specialty Plan for children and youth with special health care needs.COVID-19 related exceptional claims can be submitted via paper claim or electronically.Effective July 15, 2021, Medicaid prior authorization requirements were reinstated for behavioral health services.The waiver of service limits continues until further notice for behavioral health services. ![]()
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