Claim Submission

Claim Submission Guidelines For Alliance Behavioral Healthcare Providers (Fiscal Year 2019)

Claim Submission guidelines for providers require an attestation for claims submitted through the provider portal. The claim submission deadlines for Medicaid and State contracts are different. Both timelines are stated in the respective contracts and are also listed below.

State or Locally Funded Services

  • Original claim must be submitted within sixty (60) days of the date of service.
  • Replacement claims may be submitted within twenty (20) business days of submission of original claim. When a replacement claim is received, the original claim will be recouped and the replacement claim will be processed. If the replacement claim denies when processed, the original claim payment will not be reissued.
  • If a claim cannot be submitted by the above deadlines due to an authorization delay or AlphaMCS system correction or update, the claim must be submitted within ten (10) business days of receipt of authorization or AlphaMCS system correction or update.
  • Rate changes will be communicated in the provider newsletter and will be posted on our website unless it is provider-specific, which will be communicated via email.

Medicaid Services

  • Original claims must be submitted within ninety (90) days from the date of service.
  • Replacement claims can be submitted within ninety (90) days of the original submission date. The original claim will be recouped and replacement claim will be processed. If the replacement claim denies, the original payment will be reissued.
  • If a claim cannot be submitted by the above deadlines due to an authorization delay or AlphaMCS system correction or update, the claim must be submitted within ten (10) business days of receipt of authorization or AlphaMCS system correction or update.
  • Coordination of Benefits. Secondary claims must be submitted within ninety (90) days upon receipt of payment and or denial from primary insurance. The primary EOB must be uploaded to the patient portal at time of claim submission. Effective 01/01/16, the Provider must also submit a secondary claim within 180 days of the date of service to be within the timely filing deadline.
  • Retro Medicaid/Authorization. Should Medicaid be activated after services are rendered, the provider must submit a claim within ninety (90) days of the retroactive Medicaid being activated for unmanaged services. For managed services (requiring an authorization), the provider must submit the claim within ninety (90) days from the authorization for managed services.

Taxonomy

Beginning 8/1/17, claims must include valid Billing Taxonomy and valid Rendering Taxonomy numbers. The NPI/Taxonomy on the claim must match the information in the provider’s AlphaMCS setup as well as the information in the provider’s NCTracks profile. Claims Specialists/Analysts can assist providers with identifying which NPI/Taxonomy combinations are active for use with claims. Electronic Claim files with missing taxonomy information (blank fields) may be rejected and not processed in AlphaMCS.

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