Claims

A claims process that’s fast, transparent, and hassle-free.

At MetroPlusHealth, we’re committed to making the claims process simple, transparent, and timely for our providers and members. Whether you’re submitting a claim, checking claim status, or reviewing billing guidelines, our Claims page provides all the tools and resources you need. You’ve come to the right place to submit a claim. Learn about reimbursement policies and get answers to frequently asked questions.

Dive into the Details

How to Submit a Claim

Include a detailing of all services rendered for capitated and fee-based services
Claims must be submitted within 90 days of the date of service or discharge
You can submit a claim electronically using our Emdeon Payer ID #13265
Medical paper claims must be submitted on either HCFA 1500 or UB-04 forms
Behavioral Health paper claims must be on either CMS 1500 or UB-04 forms

For Medicaid, Child Health Plus, Essential, Partnership in Care, MetroPlusHealth Gold, Managed Long-Term Care, MetroPlusHealth Enhanced, and QHP Exchange plans, send paper claims to:

MetroPlus Health Plan P.O. Box
PO Box 830480
Birmingham, AL 35242

MetroPlusHealth Mailing Address
2500 Corporate Drive
Birmingham, AL 35242

For Medicare plans, send paper claims to:

MetroPlus Health Plan P.O. Box
PO Box 830480
Birmingham, AL 35242

MetroPlusHealth Mailing Address
2500 Corporate Drive
Birmingham, AL 35242

Tracking a Claim Status

Log into your MetroPlusHealth Provider Portal or call Provider Services at 1-800-303-9626.

Reconsiderations and Appeals

You always have the right to appeal a determination within 45 calendar days of either a payment receipt or a denial notification. Submitted appeals must include:

An explanation for the appeal
All pertinent information
A copy of the original claim

Send an appeal by regular mail to:

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

MetroPlusHealth Mailing Address
430 W 7th Street, Suite 219080
Kansas City, MO 64105-1407

Send an appeal by certified mail to:

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

Send an appeal by fax to 1-212-908-8789.

Balance Billing

Balance billing above allowed co-pays, deductibles, or co-insurance for any covered services is strictly prohibited. Providers are required to educate their staff and any affiliated providers on this requirement. Any provider who seeks payment from a member for a covered service may be subject to termination.

The Claims Submission and Reimbursement section of the Provider Manual is always a great resource to consult for additional details on all things claims.