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, 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
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, 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.
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.