Medical Foster Care (MFC)

This page provides billing and claims payment instructions for Medical Foster Care providers. Per AHCA’s guidance, MCC has established an easier process to accommodate the uniqueness of the foster care system and providers.

Checking member eligibility

Providers must verify all eligibility is active under the MCC of FL plan. Providers may obtain member eligibility information via the provider portal or by contacting Provider Services at 1-800-327‐8613.

 

Filing claims and payments

For appropriate filing information, see CMS-1500 Claim Forms Instructions” for professional or UB 04 (or its successor) Claim Form Instructions” for institutional providers. Failure to provide any of the required information can result in payment being delayed. These forms can be found on the provider portal. If you have difficulty accessing these documents, please contact us at 1-800-327-8613. MFC’s have 180 days from the date of service or discharge to submit a clean claim.

Provider Services are available Monday through Friday 8 a.m. – 7 p.m. at 1-800-327-8613

You can also use the MCC of FL website for:

  • Claims
  • Benefits
  • Eligibility

 

Or you can contact the Provider Services team directly at mccflprs@magellanhealth.com to address claims/payment questions.

 

Electronic submissions

Electronic claims are the fastest and most efficient method to get paid. EDI submission is accomplished through one of MCC of FL’s many partner clearinghouses.

You can register to submit EDI claims to Magellan Complete Care of Florida by sending an email to:

EDISupport@MagellanHealth.com or by contacting Magellan Complete Care EDI Support at 1‐800‐450‐7281, extension 75890. EDI Payor ID: 01260.

To sign up for Electronic Funds Transfer (EFT) – a secure and efficient method to receive your payments, view the EFT guide. To view steps on submitting an electronic submission click here. 

 

Paper submissions

Please ensure that claims include rendering provider information, NPI, date of service, and member information.

Submit paper claims to the following address:

Magellan Complete Care of FL

PO Box 2097

Maryland Heights, MO 63043

Payer ID# 01260

 

Process for provider reimbursement

There are three ways to submit a clean claim. Claims can be submitted through our MCC portal, a clearing house or via mail. A clean claim is a submitted claim without any errors or other issues, including incomplete documentation that delays timely payment. Depending on the type of claim submission (via mail or electronically) will determine the time of reimbursement to provider.

 

Timely filing guidelines:
Initial filing of a claim must be made in 180 calendar days from the dates of service or discharge to submit clean claim.

 

Timeline for Provider Reimbursement

  • Electronic claim– Claims submitted through any EDI system or MCC of FL portal within 15 days of receipt, MCC of FL will pay the claim or notify provider if claim is denied or contested.
  • Paper claim– When provider submits claims via mail, claims will be reimbursed within 20 days from the date MCC of FL receives the claim.

 

Direct contact information for provider assistance with MFC billing and reimbursement

Please contact Samantha Diaz at (305) 717-5303 or via email at mccflprs@magellanhealth.com for any additional claims questions.

 

Process for escalating provider complaints related to claims

Provider Services are unable to take formal claim disputes over the phone. However, if you have questions about your claims denial or about claims in general, you may call: 800-327-8613.

Please submit written claim disputes to:

P.O. Box 691029

Orlando, FL 32869