General Claims Information: MHNet provides three methods to submit claims: Electronically via a clearinghouse, web-based data entry and the old fashioned way on paper.
The fastest, most efficient way is to submit claims electronically either through our clearinghouse or our web-based system. Providers will benefit by:
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Saving Mail Time (3 to 5 days)
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Saving on postage expenses
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Saving on claim form costs
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Faster claims processing (our average payment on electronic claims is 4 business days)
MHNet relies on Emdeon as our clearinghouse. You can submit your claims from your practice management software to your current clearinghouse/vendor who will forward the claim to Emdeon or you can submit the claim directly to Emdeon. To contact Emdeon for more information you may access their website at www.emdeon.com or call 1-800-845-6592.
MHNet also offers providers an on-line method to submit claims via MHNet's website. After a simple registration process you can start submitting your electronic claims within five business days. To register you must be a participating provider and complete a Trading Partner Agreement (TPA). The agreement is a HIPAA requirement and must be signed prior to submitting electronic claims via our website. TPA agreements can be found by clicking here. Please read and sign the document and submit it to the address below.
Once MHNet receives a TPA form, we assign you a unique ID and password and you will be able to submit your claims electronically via our eclaims portal.
All paper claims and TPA forms should be submitted to:
MHNet Claims Department
PO Box 7802
London, KY 40742
Payment of paper claims averages 20 days from receipt.
Claims must be submitted within 180 days from the date covered services were provided.
To ensure timely claims payment, all submitted claims must meet the definition of a clean claim. MHNet defines a clean claim as a claim that has no defect or impropriety (including any lack of required substantiating documentation) or particular circumstance requiring special treatment that prevents timely payments from being made on the claim. To be considered a clean claim, the following items must be met:
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Have all required fields completed on a CMS 1500 or CMS1450/UB04 Form
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Include any additional data elements required by MHNet as specified in this manual or other official notices from MHNet issued periodically.
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Include all necessary attachments required by MHNet
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Include any primary payer's Explanation of Benefits (EOB) or payment voucher showing amount paid by the third party, if the member is covered by another insurance or carrier other than MHNet
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Indicate service(s) which are provided consistent with any referrals or authorizations necessary. Please note, service billed must match authorization
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Be complete, legible and accurate
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Be filed in a timely fashion in accordance with the practitioner contract
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Include all product line specific requirements as denoted by State or Federal guidelines
Regardless of your method of submission of claims information, in order for claims to be processed swiftly and accurately, the below fields are the minimum required to have your claim processed. Note: if additional information is available or needed to support the claims, please provide as appropriate.
CMS-1500 REQUIRED INFORMATION
1. Patient's ID Number
2. Patient’s Full Name
3. Address and Phone Number
4. Date of Birth
5. Signature or Signature on File
6. ICD-9 Diagnosis Code(s)
7. Date(s) of service
8. Place of Service Code/Type of Bill
9. Procedure Code/Revenue Code
10. Modifier(s) (if applicable)
11. Diagnosis Pointer
12. Procedure Charge
13. Units
14. Rendering Provider NPI
15. Rendering Provider Medicaid ID (if applicable)
16. Payee Tax ID
17. Total Charges
18. Rendering Provider Name
19. Group/Pay-to Provider Name
20. Group/Pay-to Provider NPI
21. Group/Pay-to Provider Medicaid ID (if applicable)
CMS-1450/UB04 REQUIRED INFORMATION
1. Patient's ID Number
2. Patient’s Full Name
3. Address and Phone Number
4. Date of Birth
5. Signature or Signature on File
6. ICD-9 Diagnosis Code(s)
7. Admission Diagnosis
8. Statement Covers Period
9. Date(s) of service
10. Place of Service Code/Type of Bill
11. Procedure Code/Revenue Code
12. Modifier(s) (if applicable)
13. Diagnosis Pointer
14. Procedure Charge
15. Units
16. Rendering Provider NPI
17. Rendering Provider Medicaid ID (if applicable)
18. Payee Tax ID
19. Total Charges
20. Rendering Provider Name
21. Group/Pay-to Provider Name
22. Group/Pay-to Provider NPI
23. Group/Pay-to Provider Medicaid ID (if applicable)
If you have any questions regarding the status of a claim, please call MHNet's Claims Service Now! at 1-866-992-5246. They will be happy to assist you with any questions.
If you need to resubmit a corrected claim that was previously denied, please resend your claim electronically or by mail. Please note: this information cannot be taken over the phone. We require a corrected claim copy to be on file.
If you need to resubmit a correct claim that was previously paid, please send a copy of the original remittance advice, the correct claim and note on what was corrected.