Billing Information for Providers

Saturday, February 04, 2012 Login

Members

Clients

Future Clients

Forms

These guides will assist with signing up for and submitting claims electronically.

Signing up for e-Services

EDI Claims Submission Guide

To submit Behavioral Health and Substance Abuse Claims, use the following CMS forms:

CMS-1500 Form

CMS-1450 Form

NOTE: CMS recommends the purchase of official, pre-printed forms from an authorized vendor. However, scanned versions of the updated CMS-1500 and CMS-1450 forms are available below.

For all EAP services, submit the following EAP form:

EAP Case Record Form

Additional Forms:

W-9

Member Claim Submission Guidelines and Reimbursement Form

Contact Information

MHNet Claims Department

PO Box 7802

London, KY 40742

Phone: 866.992.5246

Update: Bill Coding

Effective for all claims processed after 1 November 2009 (regardless of date of service): If you are authorized to perform a medication check (CPT code 90862), the claim you submit to MHNet must be billed with CPT code 90862 for reimbursement to occur.

Previously, this CPT code was set up such that if some similar codes were submitted, the claim would still be payable. This will no longer be the case. Thus, it is critical that your billing team be aware the authorization and claim must match for medication checks.

If you perform anything other than what is authorized, you may need to contact MHNet to have your authorization amended so the claim will pay appropriately.

Click here for MHNet's Service Code Matrix.

How to File a Claim

General Claims Information: Electronic claim submission to MHNet is easy to establish. Contact your practice management system vendor or clearinghouse to initiate the process. Electronic claim submissions will be routed through Emdeon under Payer ID 74289. Emdeon will review and validate the claims for HIPAA compliance and forward them directly to MHNet. Providers also can submit directly to Emdeon. Emdeon will provide the electronic requirements and set-up instructions. Providers should call 1.877.363.3666 or go to www.emdeon.com for information on direct submission to Emdeon.

If you have any questions, please refer to the user manual or contact the Claims Department at 1.866.992.5246.

All paper claims 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 filed in accordance with your MHNet provider contract unless otherwise mandated by Medicaid for Medicaid recipients. Non-participating providers must file according to mandate of the State in which they are filing.

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:

Have all required fields completed on a CMS 1500 or CMS1450/UB04 Form

Include any additional data elements required by MHNet as specified in this manual or other official notices from MHNet issued periodically.

Include all necessary attachments required by MHNet

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

Be complete, legible and accurate

Be filed in a timely fashion in accordance with the practitioner contract

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.