Reimbursement Policies
There’s just no way to talk claims without getting into the details. Here they are:
We prefer electronic claims because they allow us to reimburse you faster
Claims must be submitted within 90 days of the date of service, encounter, or discharge
Claims must also include a detailing of all services rendered for capitated and fee-based services
An Explanation of Payment (EOP) that summarizes the services and the payment decision will accompany all processed claims
A note on balance billing: Collecting fees is our job, so balance billing is never allowed. Outside of deductibles, copayments, or coinsurance, all payments to us are considered payments in full.
Interested in timely processing? Us too.
We ask our providers to kindly allow us 30 days to reimburse electronic claims and 45 days to reimburse paper claims. Here’s how you can help us get you paid as fast as possible:
Make sure your claim is completely filled out when you submit it
Ensure that all ICD-10 diagnosis codes (to the highest digit), CPT-4, and HCPCS service codes are valid and current on the date of service.
Got claims questions?
Give us a call with your MetroPlusHealth identification number, the date of service, claim number, and the provider’s name in hand.
Your Best Claims Friend. The Provider Manual has even more detail on all things claims, Explanations of Payment (EOPs), common forms of supporting documentation, and more. It’s a great go-to resource for getting questions answered, too.
Not a MetroPlusHealth Provider Yet? Let’s change that! Grow your practice and sign up to become one today.
Attention Medicare Providers!
While INN providers can’t make appeals themselves, you can make one on behalf of a member within 60 calendar days of the paid date on your Explanation of Payment (EOP). More detail on this process as well as how OON providers should handle appeals can be found in section 5.2.2 of the Provider Manual.
Not a MetroPlusHealth Provider Yet?
Let’s change that! Grow your practice and sign up to become one today.
