Claims FAQs
Got Claims Questions? We’ve Got Answers.
Lots of them, like these that answer some of our most commonly asked questions.
How long does reimbursement take?
We ask our providers to allow us 30 days to reimburse electronic claims and 45 days to reimburse paper claims.
How do I check my claim status?
There’s two ways: Log into the Provider Portal or give our excellent member service team a call at 1-800-303-9626.
Where do I submit an electronic claim?
Log into Change Healthcare to submit a claim electronically using our Emdeon Payer ID #13265.
Where do I send a paper claim?
For Medicaid, Child Health Plus (CHP), Essential Plan (EP), Enhanced (HARP) Plan, Partnership In Care (PIC), MetroPlusHealth Gold, and Gold Care, Managed Long Term Care (MLTC) send paper claims on CMS 1500 or UB-04 forms to:
MetroPlusHealth
PO Box 830480
Birmingham, AL 35383-0480
For Medicare plans (Advantage, UltraCare, and Platinum) and MarketPlace Plans (QHP) send paper claims on CMS 1500 or UB-04 forms to:
MetroPlusHealth
PO Box 381508
Birmingham, AL 35383-0480
Can I appeal a claim?
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.
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, Partnership In Care (PIC), Enhanced (HARP) Plan, Gold, GoldCare, Child Health Plus (CHP), Essential Plan (EP), and Managed Long Term Care (MLTC), send an appeal by regular mail to:
MetroPlusHealth
PO Box 830480
Birmingham, AL 35383-0480
For Medicare plans (Advantage, UltraCare, and Platinum) and MarketPlace Plans (QHP), send an appeal by regular mail to:
MetroPlusHealth
PO Box 381508
Birmingham, AL 35383-0480
Send any appeal by fax to 212-908-8789.
Can I talk to someone at MPH?
Absolutely! Our Provider Services Center is open Monday – Friday, 9:00 a.m. to 5:00 p.m. ET and can be reached at both 1-800-303-9626 or 1-212-908-4780.