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Provider materials and tools

Hurricane Dorian prior authorizations and claims guidelines

Due to the impacts of Hurricane Dorian on the State of Florida, Magellan Complete Care is issuing the following guidelines for providers with regard to prior authorizations and claims.

From August 29, 2019 until the executive order has expired:

Magellan Complete Care will furnish covered services:

  • Without any form of authorization
  • Without regard to whether such services are provided by a participating or non-participating provider; and
  • Without regard to service limitations
  • If a provider is not known to Florida Medicaid and rendered a service during the timeframe stated above, please complete AHCA’s provisional enrollment process to obtain a provider identification number. Magellan Complete Care can assist in this process if needed.
  • Magellan Complete Care will reimburse non-participating providers at the rates established in the Medicaid fee schedules referenced in Rule 56G-4.002, F.A.C. and the provider reimbursement rates/reimbursement methodologies. These can be accessed by the links below:

 

                http://ahca.myflorida.com/medicaid/review/reimbursement.shtml

                http://ahca.myflorida.com/medicaid/Finance/finance/index.shtml

 

At some point after the storm, depending on the Dorian’s impact, Magellan Complete care will resume normal operations except where specified below:

 

  • Magellan Complete Care will continue to comply with the removal of the early prescription refill edits until further notice

 

Claims Processing:

Magellan Complete Care continuously encourages providers to submit claims and encounters electronically. Electronic submission is less costly for the providers. Our team is trained in options for submission and is happy to schedule time with providers with questions or concerns about this method of submission.

 

Information on submission of clean claims, claims do’s and don’ts, etc. are available on the Magellan provider portal.

 

Claims and encounters submission instructions can be found on our website at the following link:

https://www.magellancompletecareoffl.com/for-providers/provider-materials-and-tools/submitting-electronic-claims/

 

Claims can be submitted:

  • Via our Direct Submit capability, allowing providers to submit claims files through a secure FTP connection or the Magellan website
  • Via clearinghouse. Magellan obtains support from multiple clearinghouses in order to provide redundancy and to offer a broad range of options for our providers. Our payor ID is 01260 for Emdeon and all other clearinghouses.
  • For out of state providers and non-PAR providers, please submit paper claims via mail to the address below:

 

Magellan Complete Care

PO Box 2097

Maryland Heights, MO 63043

 

Provisional Enrollment Process for Out of State Providers or non-Medicaid Providers

To be reimbursed for services rendered to eligible Florida Medicaid recipients from August 29, 2019 until such time as AHCA and Magellan Complete Care specify, providers who are out of the state of Florida or for providers not already enrolled in Florida Medicaid, please visit the link below to complete the provisional provider enrollment process:

http://www.mymedicaid-florida.com

 

Once you have your provisional Medicaid ID, please forward your claims to the address above.

 

Minimum Documentation Requirements: Magellan Complete Care’s claims processing unit may request clinical documentation to substantiate claims but it is not required with your initial claims submission.

 

For questions, please call our Claims inquiry line: 800-327-8613.