Claims Submission
People, Not Paperwork.
At MetroPlusHealth, 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.
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, MarketPlace, MetroPlus Gold, and Gold I and II plans, send an appeal by regular mail to:
MetroPlusHealth
P.O. Box 830480
Birmingham, AL 35283-0480
For Medicare Advantage Plans, send an appeal by regular mail to:
MetroPlusHealth
P.O. Box 381508
Birmingham, AL 35283-1508
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:
MetroPlus Health Plan
P.O. Box 830480
Birmingham, AL 35283-0480
For Medicare plans, send paper claims on CMS 1500 or UB-04 forms to:
MetroPlus Health Plan
P.O. Box 381508
Birmingham, AL 35238-1508
Where do I submit an electronic claim?
Log into Change Healthcare to submit a claim electronically using our Emdeon Payer ID #13265.
