P.O. Providers must submit a notice contesting Blue Shield's refund request within 30 working days of receiving a notice of overpayment. The date Blue Shield's claim decision, or payment, is electronically transmitted (835) or deposited in the U.S. mail (Explanation of Benefits). Overpayments from Blue Shield are to be directly refunded to Blue Shield. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. Out-of-Network Authorization Request Form-- for out-of-network providers requesting a single case agreement. Box 9000 If you have questions, call the Provider Customer Service team at (800) 541-6652 from 6:00 a.m. to 6:30 p.m. PT, Monday through Friday. The BlueCard Program links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. BLUE CROSS . By continuing to use this website, you consent to these cookies. Disputes that are returned due to missing information are resolved within 45 working days of receiving an amended dispute with missing information. We are here to help, whether you're already a network participant or just want to know more about us. Claims mailing addresses are also included in all online member eligibility results. Circumstances reasonably beyond the control of the provider that prevent the timely submission of a claim are considered "good cause". California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. You can now file disputes, attach supporting documents, and retrieve letters for submitted disputes online! You can also quickly find benefits and coverage information for common procedures and services based on your . Login to Provider Connection to start a chat, Blue Shield of California Chico, CA 95927-2540 Final disputes must be submitted within 65 working days of Blue Shield's initial determination. Likewise, EAP sessions have far more hoops, billing nuance, and prior-to-session manual labor (authorizations) involved in billing. Espaa. Ask to speak to a mental health clinician, or follow the prompts to get help with a mental health or substance use issue 24 hours a day, seven days a week. Because you have not responded to our prior notifications, we are required to suppress your information from our provider directory until you attest to its accuracy. Then, select Search. Phone: 888 CalPERS (or 888-225-7377) TTY: (877) 249-7442 Fax: (800) 959-6545 International Calls: +1 916-795-3000 We're closed on state holidays. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Find a mental health provider in the MHSA Network, Teladoc's licensed mental health providers can help you manage stress, grief, addiction, and more. When asked to log in, choose Continue as a guest. The first thing youll need to do is to find out which insurance company handles the clients coverage: Blue Shield of CA or Blue Shield MHSA. Have your member ID card ready and then follow the prompts to register and create your username and password. Blue Shield of California MHSA addresses a broad continuum of prevention, early intervention, and service needs and the necessary infrastructure, technology, and training elements that effectively support the public behavioral health system. Blue Shield of California and Magellan: A Deceptive Arrangement Every provider we work with is assigned an admin as a point of contact. Claim issues and disputes | Blue Shield of CA Provider blue shield mhsa claims address troubleshooting examples Fax: (916) 350-8860, Monday - Friday, 6:00 a.m. - 6:30 p.m. Examples of content include What you need to know about the glucose screening test during pregnancy and virtual classes such as Breastfeeding 101., Blue Shield TotalDual Plan (HMO D-SNP), Blue Shield Inspire (HMO D-SNP) or Blue Shield Coordinated Choice Plan (HMO) members, Medicare Advantage Prescription Drug Plan (IMAPD) HMO members. Blue Shield's Provider Dispute Resolution Process allows any provider that submits a dispute involving an issue of medical necessity or utilization review to the IPA/Medical Group's dispute resolution mechanism an unconditional right of appeal for that dispute. The program helps members manage pregnancy, loss/miscarriage, and three months of postpartum care. Click continue to proceed with verification. Under "Choose a Provider List," select Non-Medicare provider . Your member ID card is your key to using your medical plan benefits. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! At Magellan Healthcare, we recognize the unique challenges of the 21st century. Box 272640 Phone - Call eviCore toll-free at 855-252-1117 . Box 629010 He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. Forms - Magellan Provider Bcbs Mental Health Claims - Your Health Improve Box 272540 Regional Offices are open for appointments. Blue Shield of California is an independent member of the Blue Shield Association. We have been helping people through decades of change, leading the way in providing . Operation centers will be closed in observance of Blue Shield of Californias holiday schedule, with the exception of Medicare Member Services. We expect you to return member's call in accordance with good professional practice guidelines. When the name of a medical foundation appears on a subscriber's identification card, the benefits for that subscriber are administered by that foundation. Blue Shield/Blue Shield Promise network referrals. Hours: 8 a.m.-5 p.m. Monday-Friday (voice mail messages will be returned within 1 business day). Simply speak your request and our voice-activated system will direct your call to the appropriate representative. Explore the PCP Behavioral Health Toolkit at any time to find these resources: If you have questions about managing or coordinating behavioral health care needs for your patients with coverage under one of Blue Shields HMO or PPO commercial plans, and you dont find what you need in the PCP Behavioral Health Toolkit, contact us: Blue Shield offers maternity clinical support and coaching for pregnant members and their spouse/partner through the Maven Maternity care management program. Use of this technology can help speed receipt of payments, reduce paperwork, and improve accuracy when you submit claims, verify eligibility, obtain claim status, receive remittance advice, and receive funds transfer. Listed below, by county, are the addresses of medical foundations with which Blue Shield is affiliated. For: PCPs & RNs. List of claims mailing addresses BlueCard out-of-area program: Check subscriber ID for three-letter prefix before sending. Weve suppressed the directory info in Find a Doctor associated with one or more TINs. Tools to help you refer HMO and PPO commercial plan membersfor behavioral health services. The MHSA network provides in-network services for the majority of Blue Shield of California plans* For behavioral health providers in the MHSA network, search by provider or location: Provider: Enter a name, license, or NPI (National Provider ID) Location: Enter a specific ZIP code and refine the search with gender or other search filters. All rights reserved. We can help you sort out these sorts of things without your input whatsoever. To file a dispute online, youll need a claim number or multiple claim numbers if youre bundling claims, an email where we can reach you, and relevant supporting documents. Providers can easily start the dispute process using the online form. Phone:(866) 510-8778, Blue Shield Medicare Advantage Plan California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Included are immunizations, health screenings and more. Federal Employee Program customer services: (800) 824-8839, 8:30 a.m. to 4:30 p.m., Monday through Friday. An EOB is an outline of what services you received from a provider and how your benefits were applied to cover those services. Read Blue Shield Promise provider dispute resolution policies. Blue Shield of California Provider Services: Blue Shield of California Promise Health Plan Provider Services: Blue Shield of California BlueCard Program, Blue Shield of California Promise Health Plan, Login to Provider Connection to start a chat, Provider information and enrollment - Blue Shield of California network, Provider information and enrollment - Blue Shield of California Promise Health Plan, Credentialing Department - Blue Shield of California, Instate BlueCard Benefits/Eligibility information, Written Correspondence Status on instate claims, Status of payment (check information, paid information, etc.) Claims for capitated services provided to a Blue Shield HMO member that are erroneously sent to Blue Shield for processing/payment will be forwarded to the appropriate capitated provider within 10 working days of the receipt. We are your billing staff here to help. Phone:(510) 607-2000, Blue Shield of California P.O. The Blue Cross Blue Shield Association has two office locations. MyBlue Customer eService is your source to access your claims, view your Explanations of Benefits (EOBs) and review a summary of your healthcare finances in your Financial Dashboard. Quatretonda Email address. Verify eligibility of Blue Shield of California, Blue Shield of California Promise Health Plan, other Blue plan and Federal Employee Program members, and access associated benefits information. To ensure a considered determination, providers are asked to clearly describe the rationale for their dispute and what outcome they hope will resolve it. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Disputes submitted on a member's behalf will be treated as a member grievance and handled within the member grievance process. Blue Shield contracts require the IPA/Medical Group to establish and maintain a fair, fast and cost-effective dispute resolution to process and resolve provider disputes. Providers or capitated entities who disagree with Blue Shield's initial determination may pursue the matter further by submitting a final dispute within 65 working days of Blue Shields initial determination, or the time specified in the providers contract, whichever is greater. You can now file disputes, attach supporting documents, and retrieve letters for submitted disputes online! Contact - CalPERS Phone: (800) 468-9935 Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. Log in to Provider Connection to start the process. Find phone numbers and addresses for claims, the EDI help desk, and member appeals and grievances. 110 S Euclid Ave. San Diego, CA 92114 (877) 534-2524 The County of San Diego MHSA Issue Resolution Process has a detailed look at the process. Demographics |Electronic Data Interchange (EDI) | Recoveries, Need help with Provider Connection: Blue Shield Provider Connection Guide Provider Connection training. The Provider Dispute Resolution Process has been documented since July 1, 2004 in the Hospital and Facility Guidelines, the Independent Physician and Provider Manual, and the HMO IPA/Medical Group Procedures Manual. Forward all claims to that foundation for payment. The working date when a dispute is submitted online or delivered to the designated provider dispute post office box. Want to Reach Us? Because claims mailing addresses are different for different Blue Plan members, using the Claims Routing Tool is the most accurate way to determine a claims mailing address. We use cookies on this website to give you the best experience and measure website usage. Initial disputes must be submitted within 365 days, or the time specified in the provider's contract, whichever is greater, of Blue Shield's date of contest, denial, notice, or payment. If the resolution of a dispute results in added funds due to the provider, Blue Shield will issue payment, including interest when applicable, within 5 working days of the date of the resolution. The email address for submission will depend on your patients type of benefit plan. Blue Shield's Provider Dispute Resolution Process consists of two levels: Initial and Final. Go. A notice contesting a refund request will be identified as a dispute and follow Blue Shield's Provider Dispute Resolution Process. Provider and facilities that fail to comply will be suppressed. MHSA Contacts. P.O. IPA/Medical Groups are required to provide a tabulated report of each provider dispute received. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Montesa Postal address. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Providers may also dispute billing determinations, such as procedure codes, allowances, and the bundling and unbundling of claims; administrative policies, procedures, and terminations; reimbursement requests for overpayments; and any contract issues. Save. On the provider search page, under "Choose your Benefit Plan," select BSC MHSA. *Blue Shield of California member plans only. If you're in crisis or have suicidal thoughts . P.O. Hours: Monday - Friday, 8:00 a.m. to 5:00 p.m. Just call the number on the back of your Blue Cross ID card. The written determination of an initial dispute will notify providers and capitated entities of their right to file a final dispute. Woodland Hills, CA 91367 Examples of circumstances beyond the control of the provider, include, but are not limited to: Examples of circumstances that dont constitute "good cause": A request for information regarding claim status, member eligibility, payment methodology rules (ClaimCheck logic, bundling/unbundling logic, multiple surgery rules), Medical Policy, coordination of benefits or third-party liability/workers compensation issues. You can also quickly find benefits and coverage information for common procedures and services based on your plan in our new interactive benefits guide. Clinical. Search the professional fee schedule for Blue Shield of California allowances and learn how we establish them. Clinically approved content and virtual classes curated to the members specific milestone or need during their maternity journey. Ausias March, 546837 QUATRETONDAEspaa. Learn more about professional fee schedule. BSC offers support to moms-to-be and their partners during and after pregnancy through the Maven Maternity Program. Check out the changes and updates to our plan in 2023. Fax: (855) 895-3501. You can talk to a Teladoc provider by phone or video for a $0 copay. As private practitioners, our clinical work alone is full-time. Check subscriber ID for three-letter prefix before sending. Mailing address (for paper claims): Blue Shield of California Mental Health Service Administrator (MHSA) P.O. Forms. On the provider search page, select BSC MHSA as your "Benefit Plan" and Non-Medicare Provider under the "Provider List" drop down selection. I cannot capture in words the value to me of TheraThink. For more information, refer to the California provider handbook supplement, section 3(PDF). Monday through Friday, 6 a.m. to 6:30 p.m. LogintoProviderConnectiontostartachat. Want to view claims, statements, costs and benefits? Correct a claim Submit corrected claims within 30 working days of receiving a request for missing or additional information. Provider Search - PCP BH Toolkit Find detailed instructions for activities like checking eligibility, making a referral, determining if prior authorization is necessary, prescreening claims, checking claims status, and other tools and information you need to serve our members. Learn more about the BlueCard Program. All rights reserved. Health plans are offered by Blue Shield of California. Phone:(800) 541-6652. Contact Medical Care Solutions for questions about authorization requests, preauthorization, medical policy, and more. PDF Quick Reference Guide for Serving Blue Shield of California Members Box 272630 Blue Shield of California, FEP Ukiah CA 95482-5482 California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Monterey Park, CA 91755, Monday through Friday, 6 a.m. to 6:30 p.m. Call(877) 263-9952 to inquire about your network status with MHSA. Find information about Promise Medi-Cal and Cal MediConnect, our policies, procedures and programs. For issues related to the following functions on the Provider Connection website: Phone:(800) 541-6652, 24 hours a day, seven days a week We expect you to return member's call in accordance with good professional practice guidelines. 3335 South Fairway By phone. Available for commercial, Shared Advantage, and BlueCard. P.O. Medicare Provider Appeals Department However, if you are unable to use the Claims Routing Tool, use the current addresses listed below. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Services:. Blue Shield of California, a different company than Anthem Blue Cross of California, handles most of their mental health insurance claims by subcontracting them out (a carve out) to Magellan. (4 days ago) Join Blue Cross and Blue Shield companies and leading voices from NAMI, Business Group on Health and Morgan, Lewis & Bockius LLP as they come together to discuss strategies for addressing pandemic-amplified behavioral https://www.bcbs.com/smarter-better-healthcare/key-insights-trends/behavioral-health Category: Health Show Health

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