Emblemhealth in effect ghi

Payment depends on a number of factors including member eligibility, provider contract status, and benefit limits at the time care is rendered and the claim is processed. As an individual practitioner billing outpatient services, do I need to include the provider number on my claims? We strongly recommend billing electronically, either via EDI or our web-based direct claim submission. Please note: Billed lines are limited to 10 per claim form. In addition, please visit www.

Outpatient professional services must be billed on a CMS form. Please see the required fields listed above. If billing on paper, inpatient services and alternate levels of care e. If the provider submits a clean claim electronically within timely filing limits, compensation to the provider shall be at the rates specified in the fee schedule and paid to the provider within 30 days for electronic claim submission and 45 days for claims submitted on paper. Payformance is a vendor that partners with Beacon Health Options to deliver an electronic funds transfer EFT solution to our providers.

PaySpan Health is a multi-payer adjudicated claims settlement service that delivers electronic payments and electronic remittance advices based on your provider preferences. With PaySpan Health, you stay in control of bank accounts, file formats, and accounting processes.

What is the unique registration code number that PaySpan Health requests and how do I obtain it? Your unique registration code is the registration number that Beacon Health Options supplies to providers for enrolling in PaySpan Health. If you do not have the letter with your unique registration code, please send an e-mail to CorporateFinance beaconhealthoptions.

You will receive an e-mail with your registration code letter within three business days of your request. Note: If you recently received a payment from Beacon Health Options, your unique registration code will be located on the check stub after the marketing caption.

Licensed clinicians are available 24 hours a day, 7 days a week and days a year. As an inpatient facility, when should an authorization of an admission be requested? Pre-certification is required for all elective inpatient services. Our phone lines are open 24 hours a day, 7 days a week and days a year.

Prior approval is not required for routine outpatient services. Outpatient Services: Beacon Health Options is responsible for adjudicating claims for dates of service on or after the start date of the program. Inpatient Services: Beacon Health Options is responsible for adjudicating claims for inpatient dates of service when a member is admitted to an inpatient unit on or after the start date of the program.

Who is responsible for members admitted to an inpatient medical unit who also have behavioral health issues that need to be treated? Members admitted to a medical floor are the responsibility of EmblemHealth.

Authorization is required by EmblemHealth Prior Authorization department and claims must be submitted to EmblemHealth. If the member is transferred to a psychiatric or substance abuse unit except for medical detoxification , Beacon Health Options will need to review, authorize the care, and process the claims. Claims for dates of service in the psychiatric or substance abuse unit should be submitted to Beacon Health Options. For members seeing Beacon Health Options providers, nothing is required.

Beacon Health Options manages outpatient care via outlier management review. Beacon Health Options will notify you if a treatment plan is required. Beacon Health Options utilizes Availity Essentials verifying eligibility and benefits, claim status and other secure transactions.

If you have technical questions specific to Availity Essentials, please contact Availity Client Services at , 8 a. If, however, a paper claim needs to be sent in such as for a corrected claim , please send it to:.

Please visit us online at www. Mobile Site Search Search Field. Facebook Twitter LinkedIn. As a reminder, please ensure that you have completed your required Cultural Competency training.

If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at to share your individual provider information.

Which EmblemHealth members are not affected by the transition? The transition to Beacon Health Options does not apply to members who: Do not have a behavioral health benefit Members who have the Montefiore logo on the lower left corner of their ID cards and are being treated by a provider in the Montefiore network are not required to change providers.

They also have the option to use Beacon Health Options network providers. How does this impact me? How does the transition affect my contract with Magellan Health Services? How does the transition affect my contract with HIP? Will members receive new ID cards or ID numbers? All other ID cards: New ID cards will be issued to all other plan members as groups renew throughout the year.

The Emblem Behavioral Health Services Program Customer Service phone number will not change on the cards, but the name of the program and claims address will be updated on reissued ID cards. ID numbers: There will be no change to any member ID numbers. What do I have to do? Do I have to be credentialed by Beacon Health Options? Availity Essentials Effective March 1, , Availity Essentials is the preferred portal for verifying eligibility and benefits, claim status and other secure transactions for Beacon Health Options.

What paper forms can be used for claims submission? Auto accident? Other accident? If subject to deductible is there any interface to determine this a la NGS Connex? Will Availity have this information? As the city is probably the largest single employer in NYC this represents a significant portion of most practices and will significantly affect us all but we have received very little in the way of specific information regarding this new MA plan.

As an aside , all of my patients report they have not received any information on this subject as well. Thank you for your consideration of this matter. If this plan is approved for , the patients would have a deductible that would be slightly higher than the traditional Medicare part B deductible.

To verify this information, it is recommended to check eligibility with the local Blue Cross vendor. Providers outside of the Anthem service area can check with their local Blue Cross carrier for co-pays, deductibles, and other benefits.

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