Metro Plus Health Plan EDI Claims Submission Notes
Metro Plus Health Plan EDI Claims should be submited to Beacon Health Strategies either through electronic data interchange (EDI) connection to Beacon or via Beacon’s eServices web application. Metro Plus Health Plan EDI Claims can be submitted directly by a provider, or through a billing intermediary.
- EDI: Providers or their billing intermediaries should contact EDI operations for detailed information and to begin testing. 835/837 and 270/271 transactions are available. EDI and Emdeon claims require a plan ID associated with the levels of benefits.
- For Medicaid, Medicare and Marketplace members please bill with plan ID 131
- For FIDA members please bill with plan ID 140
- For HARP members please bill with plan ID 14
Beacon Health Strategies prefers to receive Metro Plus Health Plan EDI Claims electronically. However, if you prefer to submit a paper claim, please send to:
- For Claims Status, contact Member Services at: 1.855.371.9228, Monday through Saturday, 8 am – 8 pm.
- The timely filing deadline for claims to be submitted to Beacon Health Options is 90 days from the date of service.
- If a “clean claim” (defined in Beacon’s provider manual) is submitted in a non-electronic format, the claim will be adjudicated no later than the 45th day after the date it is received. If a “clean claim” is submitted in an electronic format, Beacon Health Options will adjudicate the claim by the 30th day after the date it is received.
- Beacon will only pay claims for covered services provided by a behavioral health provider as defined by the NY Department of Insurance.
- Beacon will develop and post on the Beacon website a provider manual for providers who provide services to MetroPlus Health Plan members before the start-up of behavioral health services. Contained within the manual will be a Claims/Billing section detailing our policies and procedures as well as other sections detailing covered services, the appeals process, quality programs and other relevant information.
- Beacon uses various reimbursement methodologies. Beacon-contracted providers that provide services to MetroPlus Health Plan members will be paid according to their Beacon contracted rate.
- Beacon Health Options’ partnership with MetroPlus Health Plan will require behavioral health providers to work directly with Beacon Health Strategies for MetroPlus Health Plan members.
Medical Health
Metro Plus Health Plan EDI Claims must be submitted detailing all services rendered for all capitated and fee-for-service encounters within 90 days of the date of service or discharge. Please allow 30 days from claim submission date to receive payment for Medicare claims, 45 days for all other claims.
- Claims for all members can be submitted electronically using Emdeon Payer ID# 13265.
- Paper claims must be submitted on HCFA 1500 or UB-04 forms.