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.
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, 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.
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
Where do I submit an electronic claim?
Log into Change Healthcare to submit a claim electronically using our Emdeon Payer ID #13265.