Billings & Payments

BILLINGS & PAYMENTS

BILLINGS & PAYMENTS

 

The following are the standard claims billing requirements for providers.

Meridian follows State Medicaid guidelines for claims payment.

Please follow these guidelines for claims submission to

MeridianComplete

:

How to Submit Claims:

For faster claims processing, we strongly encourage all providers to submit claims via electronic data interchange (EDI) or online using our secure web portal. Below you'll see the clearinghouses Meridian is currently accepting electronic claims from.

 

Submit Claims Electronically

Meridian is currently accepting electronic claims from the following clearinghouses:


Availity

Customer Support: 800-282-4548

Claim Types: Professional/Facility

http://www.availity.com



Payer ID:  

IMPORTANT: Please refer to Member ID card for changes effective on January 1, 2021, as the Payer IDs are not interchangeable.  

Date of Service

Health Plan Name

Payer ID

On or before 

Dec. 31, 2020

MeridianTotal

68069

MeridianComplete

13189

MeridianHealth Illinois

13189

On or after

Jan. 1, 2021

MeridianComplete

MHPIL

MeridianHealth Illinois

13189

On or after

July 1, 2021

MeridianHealth Illinois

MHPIL

 

 

 

Clearinghouse Enrollment for Atypical Providers

Update: National Provider Identifier (NPI) is required when billing, unless enrolled as an atypical provider. Claims will no longer be rejected at Availity for a missing NPI once you have completed the enrollment process. The rejection for a missing NPI will be received by your chosen clearinghouse and it will be their responsibility to enroll. If either the provider or chosen clearinghouse has questions about the process of enrolling as an atypical provider, you can contact the Client Services team at 1-800-Availity.

 

MeridianComplete

may add new clearinghouses from time to time, so please contact Provider Services at

1-855-580-1689

to see if your clearinghouse partner is on the list.

 

Submit Claims By Mail

You can also submit claims for payment through the mail:

 

After 1/1/2021, please use the following address for mailed claims: 

MeridianComplete
ATTN: Claims Department
PO Box 3060
Farmington MO 63640

 

For 2020 dates of service, please continue to use this address:

 

 

MeridianComplete

1 Campus Martius, Suite 720
Detroit, MI  48226
Attn: Claims Department

 

If you are re-submitting a claim for a status or a correction, please indicate “Status” or “Claims Correction” on the claim.

 

Claims Billing Requirements:

  • Lab claims must be submitted on a CMS 1500 or Illinois 2360 Form
  • Providers must use a standard CMS 1500 Claim Form or UB-04 Claim Form for submission of claims to Meridian
  • Providers must use industry standard procedure and diagnosis codes such as CPT, Revenue, HCPCS and ICD-10 when billing Meridian
  • Specialty physician claims should include a PCP referral form and/or a corporate prior authorization number for payment
  • Providers may also submit and check the status of claims electronically via the secure Meridian Provider Portal
  • Claim must be original, using national or state form types as applicable. Photo or scanned copies are not accepted. The claim information must be typed, with no hand-written information other than applicable signatures

MEDICARE DISCLAIMER

MeridianComplete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.

 

You can get this document in Spanish, or speak with someone about this information in other languages for free. Call

1-855-580-1689 (TTY users should call 711)

,

Monday - Sunday, 8 a.m. to 8 p.m.

  The call is free.

 

Usted puede obtener gratuitamente este documento en español o hablar con alguien sobre esta información en otros idiomas. Llame al

1-855-580-1689

(los usuarios de TTY deben llamar al 711), lunes a domingo, de 8 a.m. a 8 p.m. La llamada es gratuita.

 

Limitations, copays, and restrictions may apply. For more information, call MeridianComplete Member Services or read the MeridianComplete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.

 

For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at

1-855-580-1689 (TTY users should call 711)

.

Page Last Modified: 4/5/2022 2:50:09 PM