Claims Submission

People, Not Paperwork.

Submitting claims accurately and efficiently is an important part of providing care, and MetroPlusHealth makes the process straightforward with our Provider Claims Submission resources. We’re all about doing everything we can to make our providers’ paperwork lives as easy as possible. We’re proud of our fast, easy, and frictionless claims process that lets you get back to doing what you got into this business to do in the first place: Take excellent care of your patients.

Doctor or healthcare provider using a computer to submit insurance claims through MetroPlusHealth. — *Streamline provider claims submission with MetroPlusHealth’s secure and efficient online portal.*

Claim Tracking Made Easy

Want to follow a claim’s reimbursement status? Log into our Provider Portal to track all of your claims’ statuses in one, easy-to-use place.

Frequently Asked Questions About Claims

How do I file an appeal?

Our claims department also handles all appeals. You always have the right to appeal a determination within 45 calendar days of either a payment receipt or a denial notification.

All appeals of claim denials that result from authorization or medical management issues should refer to section 7.15 of the Provider Manual.

For all other claims, be sure to include:

An explanation for the appeal
All other pertinent information and supporting documentation
A copy of the original claim
A copy of the original EOP
For Medicare appeals only, an AOR form (INN) or a WOL statement (OON)

For Medicaid, Medicaid Advantage Plus (MAP), SNP, HARP, MLTC, CHPlus, Essential, MetroPlus Gold, and Gold I and II plans, send an appeal by regular mail to:

MetroPlusHealth
P.O. Box 219080
Kansas City, MO 64121-9080

For Medicare Advantage Plans and MarketPlace QHP, send an appeal by regular mail to:

MetroPlusHealth
P.O. Box 219374
Kansas City, MO 64121-9374

Send any appeal by certified mail to:

MetroPlusHealth
Attn: Claims
50 Water Street, 7th Floor
New York, NY 10004

Send any appeal by fax to 212-908-8789.

Where do I send a paper claim?

For Medicaid, Medicaid Advantage Plus (MAP), Child Health Plus, Essential, HARP, SNP, Partnership in Care, MetroPlusHealth Gold, Gold Care I and II, Managed Long-Term Care, MetroPlusHealth Enhanced, MarketPlace, and QHP Exchange plans, send paper claims on CMS 1500 or UB-04 forms to:

MetroPlusHealth P.O. Box
430 W 7th Street, Suite 219080
Kansas City, MO 64105-1407

For Medicare plans, send paper claims on CMS 1500 or UB-04 forms to:

MetroPlus Health Plan P.O. Box
PO Box 219080
Kansas City, MO 64121-9080