For Providers

Getting Paid

Claim Presentation (1301 KB PDF)

Provider Financial Reporting Guide (96K PDF)

Electronic Funds Transfer Form (for block providers only) (63 KB PDF)

At Magellan, we understand that getting your claims paid promptly and correctly is critical to the success of your practice. To assist you in submitting and tracking your claims, and receiving prompt and accurate payment, we provide a number of tools and resources.

By signing in to the Magellan Provider web site with your secure username and password, you can submit a claim online and check claims status. You can also sign up for electronic funds transfers (EFT).

Electronic Claims Options for Providers

Magellan Health Services of Arizona has developed a suite of electronic claims submittal offerings to best serve the needs of our Maricopa County providers for timely claims processing.

Direct Submit

If you are able to submit electronic claims in a HIPAA-compliant 837 format, we recommend our EDI Direct Submit Testing Application. This application provides a secure method to send HIPAA transaction files directly to Magellan and is available at no cost to our providers submitting 160 or more claims per month. We offer two alternatives for claims submission: PGP encrypted files via FTP and files sent through the Web site.

Using this method for transmitting claims to Magellan allows you to:

• Use a secure method for transmitting claims
• Eliminate or avoid clearinghouse costs
• Submit multiple claims in batch mode
• Send files at any time - 24 hours a day, seven days a week

If you are unable to submit electronic claims in a HIPAA-compliant 837 format, we offer other options to meet your needs. Please note that providers currently using the ValueOptions software to create electronic claims in an 837 format will not be able to use this tool to submit claims to Magellan.

For more information, please visit www.edi.magellanprovider.com.

Submit a Claim Online

Also known as Claims Courier, this Web-based data entry application is accessible 24 hours a day and allows users to efficiently submit professional claims on Magellan’s Web site. Providers can manually enter claims data into Web screens in this user-friendly application. For more information, visit www.MagellanofAZ.com under the “For Providers” section and login to the secure provider site to utilize this application.

Clearinghouse Submission

For submitters who are not able to use Magellan’s no-cost options (Direct Submit or Claims Courier) and do not have the capability to create an 837, we recommend the use of a clearinghouse. Magellan is contracted with five clearinghouses identified below.

Please note that Magellan has a special arrangement with NaviNet, a clearinghouse which provides setup and transactions at no cost to our providers.

Magellan Approved Clearinghouse	Phone Number	Web Address
NaviNet Claims	800-526-7276	www.navinetclaims.com
PayerPath	877-623-5706	www.payerpath.com
MedAvant Healthcare Solutions (formerly ProxyMed)	800-586-6870	www.medavanthealth.com
Availity (formerly THIN)	800-282-4548	www.availity.com
Emdeon Business Services (formerly WebMD)	615-885-3700	www.transact.emdeon.com

If you currently have arrangements with a clearinghouse that is not approved by Magellan, you can simply arrange for your clearinghouse to contact one of the approved clearinghouses to arrange for transmission of claims.

It is important to include:

• Magellan’s Maricopa County P.O. Box: 67090
• Your National Provider Identifier (NPI) number and Taxpayer Identification Number (TIN)

If you have questions regarding electronic claims submission, please e-mail them to EDISupport@MagellanHealth.com for resolution.

EDI Testing Center for High-Volume Providers

Our EDI Direct Submit Testing application is an electronic claims tool available on www.edi.magellanprovider.com. This application is offered at no cost to our high-claims-volume providers and is limited to providers submitting at least 160 claims per month. This application can be used to send HIPAA transaction files directly to Magellan, allowing you to receive response files without the use of a clearinghouse. The HIPAA transaction files that Magellan currently supports include the 837P and 837I claims submission files. Files sent to Magellan will be validated, and if certification is granted, you will be permitted to submit claims files and receive responses.

Using this method for transmitting claims to Magellan allows you to:

• Use a secure method for transmitting claims
• Eliminate or avoid clearinghouse costs
• Submit multiple claims in batch mode
• Send files at any time - 24 hours a day, seven days a week

When you access the EDI Testing Center site, you will register for a new account, complete a survey and then submit test files using our EDI Testing Center. An IT analyst will be assigned to support you during the process. You will be required to submit a minimum of two test files that successfully process and return response files before Magellan will permit submission of files to production (i.e., live claims processing).

We offer two alternatives for claims submission: PGP encrypted files via FTP and files sent through the Web site.

If you have any questions about the process, contact us at EDISupport@MagellanHealth.com.

For additional information on Magellan claims, please visit Provider Claims Resources.

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