Provider materials and tools

Medical Foster Care (MFC) provider education

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 MCC plan. Providers may obtain member eligibility information via our MCCFL Eligibility Information or by contacting Customer Service 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 Magellan Complete Care 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.

 

Customer Service Center, available Monday through Friday 8am - 7pm: 1-800-327-8613

You can also use the Magellan Complete Care website for:

  • Claims
  • Benefits
  • Eligibility

www.MagellanCompleteCareofFL.com

Or you can contact the Provider Servicing team directly using the following mailbox to address claims/payment questions: mccflprs@magellanhealth.com

 

Paper Submission

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

 

Electronic Submission

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

You can register to submit EDI claims to Magellan Complete Care 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, visit the EFT page of our provider website. For a complete list of all of the Clearinghouse vendors and simple steps on how to register please visit the MCC website:

MCCFL Electronic Submissions

 

Link to online training materials

Please refer to MCC FL Online training materials and MCC provider manual

 

Approved Medical Foster Care Service Codes

Level

Codes

Allowed modifiers

Description

I

S5145

HA

Level I Medical Foster Care service

II

S5145

TF

Level II Medical Foster Care service

III

S5145

TG

Level III Medical Foster Care service

 

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 portal within 15 days of receipt, Magellan Complete Care 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 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

Customer Service is 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:

PO Box 691029

Orlando, FL 32869

 

Provider Webinar and training materials

Please refer to MCC FL for Webinar and provider training materials.

MCCFL Provider Training

 

If you need additional resources, please visit our provider website at:

MCCFL Provider Site