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IMPORTANT change effective October 1, 2013 for MHNet providers who also are contracted with Aetna and receive EFT payments.
As part of the Coventry Health Care and Aetna integration, you will start to see EFT payments from the Coventry plans where you previously received paper checks. We will use the banking information you previously provided to Aetna for your claims payments. If you have an e-mail address on file with Aetna, you will get an e-mail advising you when EFT is set up in Coventry’s system. Please follow the instructions contained in the email to set up your favorites list by accessing the MHNet’s provider portal at www.MHNetProvider.com. When EFT payments begin, remittance advices will no longer be printed and mailed. Remittance advices are available online, anytime, for free at our provider portal. If you use ERA (835) there will be no impact. This doesn’t change the way you submit claims to Coventry or Aetna today. You should continue working with Coventry and Aetna and servicing our members as you have been. E-mail us at email@example.com if you have any questions.
REMINDER! All appeals or complaints regarding claims payment must be filed within 180 days of the processing date.
Timeframes for claims filing are as follows:
- Participating providers – in accordance with your MHNet provider contract unless otherwise mandated by Medicaid for Medicaid recipients or Medicare for Medicare recipients.
- Non-Participating providers – in accordance with mandate of the state in which you are filing; Medicaid mandate Medicaid recipients; or Medicare mandate for Medicare recipients.
All the claims information you need is here!
MHNet values the quality care that providers give to our members and it is our goal to provide prompt reimbursement for those services. A key factor in getting claims processed in a timely manner is correct claims submission. Submitting a claim correctly the first time increases the cash flow to your practice and prevents costly follow-up time by your office or billing staff. A detailed document, How to File A Claim, includes information for electronic or paper submission and it outlines the required fields of the claim form. Providers can find copies of the CMS-1500 and the UB-04 claims forms in our Forms Library section, at the bottom of the page. Please remember that all providers must bill with currently valid ICD diagnosis codes, including all 5 digits. Refer to the ICD website directly for an up-to-date listing.
Here is a claims presentation for you to review independently or you can join our live presentation which is available the second Friday of every month at 12noon CST. To reserve your spot, send us an email at firstname.lastname@example.org with your name, the providers name, state, contact phone, email address and the date of the Friday training you want to attend. We will send you a confirmation with the conference line information.
MHNet encourages providers to submit claims electronically, as this allows for faster payment. Electronic claim submission to MHNet is easy to establish, just contact your practice management system vendor or clearinghouse to initiate the process. Electronic claim submissions are routed through Emdeon under Payer ID 74289. Providers also can submit directly to Emdeon. Emdeon will provide the electronic requirements and set-up instructions, simply call 877.363.3666 or go to www.emdeon.com for information.
All paper claims should be submitted to:
PO Box 7802
London, KY 40742
Timely filing guidelines are set in accordance with your MHNet Practitioner Agreement, unless otherwise mandated by Medicaid for Medicaid recipients. As noted in section 5.2 of the standard contract, billing should be submitted within 90 days of the date of service. All participating providers should reference their personal contracts for verification of this requirement. Additionally, CMS defers to the standards established in the participating provider contract for Medicare products; therefore, billing for Medicare members would also follow this timeline.
Timely filing for Medicaid products is mandated by the State; therefore, the State Medicaid timely filing requirement prevails for Medicaid members. In Missouri, Kentucky, Virginia, and Florida, timely filing is 365 days for Medicaid products.
Nonparticipating providers are under the timely filing mandate of the State in which they practice.
Online, Real-time Claims Inquiries
Our secure Provider Portal has the Claim Inquiry section where you can view claims by status (Paid, Pended, Denied, Rejected) and search for claims by member, claim number, or date range, for any 30-day period since September 2011. Claims disposition codes are easy to understand and each claim clearly displays member responsibility. You can see Remittance Advices and even print them for your records. For more information and details on how to register for this free service, just go to the MHNet Provider Portal page.
Remittance Advices, EFTs, and ERAs
Click here for the Remittance Advice Summary that has very detailed instructions on how to read our Remittance Advice. Please note that the RA also shows active claims that are in process or pending payment to keep you informed on the claims progress.
MHNet offers Electronic Fund Transfers (EFTs) and Electronic Remittance Advices (ERAs) to facilitate your billing processes. For specific information concerning EDI claims and other electronic solutions, please refer to the EDI Documentation page and click on the EFT Quick Guide. To sign up for EFTs, click here for the EFT registration form. Please note that a voided check must be submitted with the EFT form to process your request. Your first direct deposit of payment will indicate the processing is complete!
There are scenarios where a member's copay exceeds the provider's contracted amount and MHNet wants to clarify the appropriate process for when this occurs. If the provider is aware of the service and contracted amount before rendering the treatment, the provider should not accept a copay amount from the member that exceeds their contracted rate. If the member pays their entire copay upfront, the provider will be required to reimburse the member, as instructed by the Remittance Advice from MHNet.
Click here for the OON Provider Claims information document to assist non-participating provider in their billing process.
MHNet takes Fraud and Healthcare Abuse issues seriously. To learn more and find out how to report your concerns, click here.
Feel free to call the Claims Department at our toll free number, 866.992.5246 or 866.99CLAIM, to answer any claims questions.