Claims Information

Please see below for information and instructions regarding claims pertaining to Behavioral Health services:

Claims must be submitted detailing all services rendered for every encounter within 90 days of the date of service or discharge

• This applies regardless of whether the provider is paid on a capitated or fee-for-service methodology

Please allow 30 days for electronic and 45 days for paper claim submission date to receive payment.

Claims for all members can be submitted electronically using MetroPlusHealth Emdeon Payer ID# 13265.

Paper claims must be submitted on CMS 1500 or UB-04 forms

• Send paper claims for Medicaid, CHP, EP, SNP, MetroPlusHealth Gold, Managed Long-Term Care (MLTC), MetroPlusHealth Enhanced (HARP) and QHP (Exchange) to:

MetroPlusHealth Health Plan
P.O. Box 830480
Birmingham, AL 35283-0480

• Send paper claims for MetroPlusHealth Medicare to:

MetroPlus Health Plan
P.O. Box 381508
Birmingham, AL 35238-1508

If you disagree with a claim payment determination, you have the right to appeal. You must explain the reason for the appeal and include:

All pertinent information as well as a copy of the original claim. Claims must be submitted in writing within 45 calendar days of the date of the original check or denial notification.

In writing: MetroPlus Health Plan
P.O. Box 830480
Birmingham, AL 35283-0480

Certified Mail

MetroPlusHealth Plan
50 Water Street, 7^th Floor
New York, NY 10004

By phone: 800-303-9626
By fax: 212-908-8789