Provider materials and tools

Submittting electronic claims

Instructions for use

The Submit EDI Claims/Files application can be used to send HIPAA transaction files directly to Magellan and to receive responses from Magellan without the use of a clearinghouse. The HIPAA transaction files that Magellan currently supports include the 837P and 837I claims submission files and 834 eligibility files. Files sent to Magellan will be validated, and if certification can be granted, the user will be permitted to submit files and receive responses.

Using this method for transmitting files to Magellan allows providers to:

  • Use a secure method for transmitting claims and eligibility
  • Submit multiple claims in batch mode
  • Eliminate clearinghouse costs by submitting directly to Magellan
  • Send files at any time – 24 hours a day, 7 days a week


Getting started

Before you can submit files to Magellan, you must register and submit test files using our EDI testing center.  Only providers who cannot submit PGP encrypted files via FTP will use the Submit EDI Files application on the Magellan website.

If you currently submit files through a clearinghouse, you can continue to do so while you are in the process of certifying electronic files with Magellan. Once you begin submitting production files directly to Magellan through the Submit EDI Files application, you will need to discontinue sending Magellan claims or other files through your clearinghouse. Submitting claims to both your clearinghouse and through the Magellan Submit EDI Files application could result in duplicate claims submission to Magellan. Duplicate claims will be denied by Magellan.


Adding users

Multiple users within your organization can be set up to use this application. The user identified as the Administrator is able to grant permissions to other users in the organization. Be aware that the application will not allow multiple users to send and receive files at the same time.


Sending a file

After successful submission of test files through our EDI Testing Center, Magellan will notify you that you are able send production files. Magellan will require you to submit a minimum of two test files that successfully process and return response files before we will permit submission of files to production.

When sending HIPAA 837P and 837I transaction files, the Magellan preferred standard is one claim per ST/SE.  If it is necessary for you to submit more than one claim per ST/SE, Magellan can typically accommodate this request.

For Arizona providers serving Maricopa County members, the 834 eligibility transaction type includes intake, demographics and closure file formats.


Steps for sending a file

  1. After signing in to the Magellan provider website, click Submit EDI Files on the left-hand menu under My EDI.
  2. On the Welcome to Submit EDI Files page, click the Send/Get EDI Files tab.
  3. On the Send/Get EDI Files screen, note the registration and certification status in the upper-right corner. This will indicate the transactions for which you may submit production files.
  4. Before you send a file, note the list of files that have previously been sent to Magellan. Please do not attempt to send the same file if it has already been successfully sent to Magellan.
  5. Click on the Send File button.
  6. A Send Files window will require that you select the Transaction Type.  Browse to the file you wish to send using the Select File button. If you set this path as your default, the application will automatically browse to this same location the next time you indicate that you want to send a file.
  7. After sending the file, you will receive immediate confirmation that the file was successfully transmitted, or that an error was encountered. The Sent Files section of the Send/Get EDI Files page will display the newly sent file.


Getting a file

Within approximately 24 hours of successfully submitting a file to Magellan, response files will be available for retrieval. You will need to check for availability of files through the Submit EDI Files application, as you will not receive any notice that response files are available.


Steps for getting a file

  1. After signing in to the Magellan provider website, click Submit EDI Files on the left-hand menu under the My EDI section.
  2. On the Welcome to Submit EDI Files page, click the Send/Get EDI Files tab.
  3. Response files will be listed in the Get Files section.
  4. Click the All check box and then the Get Selected Files button to download all available files. If you choose to download only select files, click the individual check box(es) associated with files you want to download, then the Get Selected Files button. If files available for download include multiple transaction types, you can use the Search Files function to refine the results before downloading files.
  5. Some response files that you may receive include:
    • TA1 – indicates whether the file was received and could be read
      • Positive TA1 means the file will continue processing.
      • Negative TA1 means the file was corrupt and you will need to fix and re-transmit it.
    • 997 – indicates if the file was X12/HIPAA compliant; this file will only be returned if you had a positive TA1
      • Each transaction set is acknowledged within the 997 with an accept or reject message
    • X12/HIPAA Status Report – This is a Magellan proprietary file that provides a status for each claim you submitted. As with the 997, this file will only be returned if you had a positive TA1
      • Accepted – each claim that is accepted as compliant for X12/HIPAA edits will be noted with an “Accepted” message.  These claims will continue processing.
      • Rejected - each claim that is rejected as non-compliant for X12/HIPAA edits will be noted with a “Rejected” message and a description of the error.  These claims will not continue processing. You will need to fix the error and resubmit the claims in a new 837 file.
    • 277U Response File – This is an X12 file format that provides a response for each claim that was “Accepted” on the X12/HIPAA Status Report. 
      • Accepted – any claim that is accepted on the 277U response file is now in the adjudication process. 
      • Rejected – any claim that is rejected on the 277U response file will not enter the adjudication process.  You will need to correct the claim and resubmit it in a new 837 file.
    • 835 Electronic Remittance – this is the X12/HIPAA format for remittance information, it will include payment or denial information for each claim. 
      • This file is optional and will only be received if you submit a written request for Electronic Remittance Advice.
      • If you do not choose to use the 835, payment and denial information will be sent on paper remittances through US mail.
  6. Because PGP encryption is not used for Web submissions, you will be given a password to unlock the files. Magellan’s standard is to send the response files as self decrypting archive (SDA) files as executables (.exe file). If you will not be using PGP and cannot accept executable files, we can convert the response files to text files (.txt file) upon request. To request text files, contact us at EDISUPPORT@MagellanHealth.com.
  7. After downloading files, you will receive immediate confirmation that the files were either successfully transmitted, or that an error was encountered. The Get Files section of the Send/Get EDI Files page will display the status of the files that were selected for retrieval.
  8. If response files are not available within 48 hours after sending a file, a problem may have occurred. If 48 hours have passed and Magellan has not already contacted you, please notify us at EDISUPPORT@MagellanHealth.com.


Searching for files

Sometimes it may be necessary to research whether a file has already been sent or received. The Submit EDI Files application allows you to refine the list of files that have been sent and received to enable you to manage your file transmission activity.


Steps for searching for files

  1. After signing in to the Magellan provider website, click Submit EDI Files on the left-hand menu under My EDI.
  2. On the Welcome to Submit EDI Files page, click on the Send/Get EDI Files tab.
  3. The 10 files most recently sent and received will display on this page. To see additional files use the <Prev and Next> links.
  4. To refine the list of displayed files use the Search Files section and enter the search criteria that you want. If you do not select a choice within a section, all files for that section will be selected. 

 

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