Become a Provider
If you would like to apply to join the Blue Choice Behavioral Health Network please contact the MHCA marketing department at: mhcanetworks@mhcausa.com
or 866-334-6422.

Billing And Claims

Important Information


New Monthly Webinars!

To register:  please email Jamie Taylor, CPB –Director of Provider Education

Jamie.taylor@mhcausa.com

 

ICD 10 was implemented October 1,2015
All dates of service October 1,2015 and after must have the ICD-10 codes.
Dates of service prior to October 1, 2015 can use the ICD-9 codes.

For more information:
www.ama.com
www.masalink.org
www.cms.gov

ELECTRONIC CLAIMS FILING:

 Providers are encouraged to submit claims electronically. Advantages of electronic claims submission are:

  • Improved accuracy of billing and diagnostic coding
  • Reduction of errors and need for refilling claims
  • More rapid payment to providers for services provided

Options for electronic claims processing

 MHCA partners with:  

  • Office Ally – for information visit Office Ally: www.officeally.com; an enrollment form is required.

For all vendors, use the following Payer IDs
MHCA 2 (Blue Choice)  or  MHCA 1 (EPS)

MHCA Claims Department Contact Information:

  •  Claims Processing Phone Number: 205-949-4539  Calls are answered live.
  •  Claims Processing Fax Number: 205-949-4535 (please do not fax claims unless asked to)

Mailing address for claims:

MHCA
Attention: Claims Processing
956 Montclair Road
Suite 200
Birmingham, Alabama 35213

Mailing address for claims appeals:

MHCA
Attention: Claims Appeals
956 Montclair Road
Suite 200
Birmingham, Alabama 35213

CLAIMS TO FILE WITH MHCA

Blue Cross and Blue Shield of Alabama contracts covered by Blue Choice Behavioral Health Network:

  • Blue Advantage
  • Federal Employee Plan (FEP)
  • State Employee Plan (SEIB)
  • ALL Kids
  • Out of state Blue Cross and Blue Shield contracts if part of the Blue Card PPO unless mental/nervous benefits are managed by Magellan, Value Options, etc.
  • Public Education Employees’ Health Insurance Plan  PEEHIP (EDU)

 

TO OBTAIN BENEFITS AND ELIGIBILITY

Go to the BCBSAL website, www.bcbsal.org or call the number on the member’s benefit card. MHCA does not provide benefit and eligibility verification.

 General Rules:

  • To obtain benefits and eligibility, call the number that is on the patient’s insurance card
  • Ask if the patient is primary or secondary on the contract
  • When the customer service representative asks if you are in-network with the local PPO/BCBS, say “Yes”.  This will ensure that you will be given the in-network level of benefits
  • Ask if pre-certification is required
  • Ask where the claims for mental/nervous/substance abuse should be filed. If claims are to be filed to companies such as Magellan, Value Options, etc., that contract is not one that is a part of the Blue Choice Network.

INFORMATION REQUIRED ON A CMS 1500 WHEN FILING CLAIM TO MHCA

  • All patient information (boxes 2, 3, 5, 6, & 8 )
  • Primary insurance information if filing a secondary claim (boxes 9, a, b, & d)
  • All insured information (boxes 1a, 4, 7, & 11a)
  • INSURED’S POLICY GROUP NUMBER (BOX 11) – claim will be denied if not entered for BCBSAL and FEP contracts.
  • Patient’s or authorized person’s signature (box 12)
  • Insured’s or authorized person’s signature (box 13)
  • Referring physician and NPI number if applicable (boxes 17 & 17b)
  • Diagnosis code (box 21)
  • Prior authorization number/Pre-Cert # if applicable (box 23)
  • Dates of Service (box 24a)
  • Place of Service (box 24b)
  • Emergency if applicable (box 24c)
  • Procedure code/CPT (box 24d)
  • Diagnosis pointer (box 24e)
  • $ Charges (box 24f)
  • Days or Units (box 24g)
  • Rendering Provider NPI # (box 24j)
  • Federal Tax I.D. Number (box 25)
  • Patient’s Account number (box 26)
  • Accept Assignment? (box 27)
  • Total Charges (box 28)
  • Signature of Physician/Provider (box 31)
  • Service Rendering address (box 32)
  • Billing provider info & phone number (box 33)

FEE SCHEDULES

A copy of the Blue Choice fee schedules are attached to your Participating Provider Agreement. If you need to request a copy of the fee schedules, contact Evelyn Barbee at evelyn.barbee@mhcausa.com or 866-334-6422. MHCA credentialed providers may also find the fee schedules through the secure access portal under Provider Fee Schedules on the MHCA website: www.mhcausa.com.

(NOTE: In order to receive maximum payment/reimbursement, bill your normal fee for each procedure and not the fee schedule amount for that procedure.)

PAYMENT WAS APPLIED TO PATIENT’S DEDUCTIBLE, BUT WHEN CHECKING BENEFITS WAS TOLD PATIENT DID NOT HAVE A DEDUCTIBLE

 Payments and rejections are posted as remitted to our office from insurance plans. If payment does not coincide with information provided  at the time of benefit verification, contact the customer service number on the card to request reprocessing of claim.

CLAIM WAS DENIED WITH B13 (DUPLICATE/PREVIOUSLY PAID) BUT DO NOT HAVE RECORD OF MHCA PROCESSING

 MHCA claim information is posted as remitted to our office by the BCBS Plan. In cases in which claims reject as duplicate or previously paid  and you do not reflect record of claim being processed by MHCA, you will need to contact BCBSAL directly. Most often these claims are  rejected on the MHCA remittance notice because claims were previously submitted directly to BCBSAL by the provider. If the claim was filed  directly to BCBSAL in error, please have them refund/negate the claim and submit a corrected claim to MHCA for processing.

SENDING IN A CORRECTED CLAIM

 When submitting a corrected claim to MHCA, please be sure to write “Corrected Claim” on the claim form and circle the information that is  being corrected.

CLAIMS STATUS/QUESTIONS

 Please call the MHCA claims department at 205-949-4539 for claims questions.

 To check status of a large volume of claims, please email the MHCA claims department.

 You may also email your questions to mhcaclaims@mhcausa.com, or you may fax your question to 205-949-4535.

 To check status of a large volume of claims, please email the MHCA claims department.

 In order to efficiently and accurately answer your claims questions, please include the following information when submitting your requests:  your name, provider’s name, phone number, fax number, and email address.

 If you have questions about a check/EOB received, please include the claims number and the question about the claim.

 If you have a claims status question, please provide the BCBS contract number, provider name, patient’s first name, patient’s date of birth,  and the date of service. We will reply to you within 24 work hours.

 Any omission of the required data may result in your request being unanswered or delayed.

© 2014 Managed Health Care Administration.
All rights reserved.