Member Services: 1-844-243-5187 (TTY use 711) Available 8am - 7pm Monday - Friday | Language Assistance

Claim Submission


MCHP encourages all providers to submit claims electronically.
Providers interested in electronic claim filing may contact your EDI (Electronic Data Interchange) software vendor or the Change Healthcare (formerly Emdeon) Provider Support Line at (800) 845-6592 to arrange transmission.

Providers may also self-register to our MCHP Web Connect Live Portal at https://office.emdeon.com/vendorfiles/MCHP.html. Once registered, providers can utilize the same link contained within our website to submit claims. The step-by-step online registration instructions for MCHP Web Connect Live Portal can be found by clicking here.

Miami Children’s Electronic Payer ID:  82832
 
The benefits of submitting EDI claims include:

• Improved cost effectiveness
• Improved claims tracking
• Electronic acknowledgment of claim receipt
• Faster payment of claims
• Better turnaround time for timely reimbursement

For paper claims, please submit to MCHP at the following address:
 
Miami Children’s Health Plan
PO BOX  211241
Eagan, MN 55121
 

Timely Filing

180 calendar days from the date of service or date of discharge (inpatient), or as specified in provider contract.
 

Corrected Claims

Corrected claims can be sent electronically or via paper to:

    Miami Children’s Health Plan
    PO BOX  211241
    Eagan, MN 55121
 
All corrected claims should have the corrected claim indicator (7) on the claim and the original claim number that you are correcting.
 
Claims originally denied for missing/invalid information for inappropriate coding should be submitted as corrected claims.

 

Interim Billing for Inpatient Hospital Stays


Below is the process for interim billing for inpatient hospital stays that exceed one hundred (100) consecutive days. This applies to hospital providers that request assistance due an enrollee’s protracted length of stay greater than one hundred (100) days and due to the financial strain it imposes in having to wait for the enrollee to be discharged to seek reimbursement.
 
  • To use the interim billing process, please submit the claim with the appropriate bill type (listed below).
  • To submit interim claims, please use the following Bill Type to identify an Interim claim.
    • Interim bills must include the following:
      • Initial interim bill:
        • Admission or Start of Care Date
        • Statement Covered “From” date must equal the admission date
        • Patient discharge status of “30” still a patient
        • All diagnosis and procedure codes relating to that time period
        • Bill Type 112 - 1st Interim Claim
      • Continuing interim bill:
        • Admission or Start of Care Date
        • Statement Covered “From” date must NOT equal the admission date
        • Patient discharge status of “30” still a patient
        • All diagnosis and procedure codes relating to that time period
        • Bill Type 113 - Continuing
      • Final interim bill
        • Admission or Start of Care Date
        • Statement Covered “From” date must equal the admission date
        • The Statement Covered “Through” date must reflect the date of discharge for the admission
        • Patient discharge status “follow your normal discharge status rules for appropriate status code”
        • All diagnosis and procedure codes relating to the entire admission
        • Bill Type 117 – Last Claim
        • The previous claims received for interim billing will be voided and replaced with subsequent claims
  • For questions concerning this process, please call Provider Services at 1-844-243-5188 or email providerrelations@miamichildrenshealthplan.com

 



 

 

 

 

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Miami Children's Health Plan is a Managed Care Plan with a Florida Medicaid Contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Managed Care Plan. Limitations, copayments, and/or restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change.

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