Claims Submission:

All paper claim submissions are to be mailed to the following P.O. Box:

Extended MLTC Provider Claims
P.O. Box 21446
Eagan, MN 55121

 

All Claims that are being Resubmitted (Corrected Claim) or for an Appeal on a Claim

Please label the envelope and Claims form appropriately and mail to the following P.O. Box:

Extended MLTC Provider Correspondences
“Corrected Claim” or “Claims Appeal”
P.O. Box 21446
Eagan, MN 55121

Timely Filing Limits:

PARTICIPATING PROVIDER
Initial Claims: 90 days from the date of service
Corrected Claims: 180 days from the date of service

NON-PARTICIPATING PROVIDER
Initial Claims: 120 days from the date of service
Corrected Claims: 180 days from the date of service

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Electronic Claims Submission:

The Extended MLTC Emdeon payer ID # is 46166.

Emdeon supports both professional and institutional claims.

(1) CMS-1500 (formerly HCFA 1500) This billing form is used for professional services. For instructions on completion of the CMS-1500 please refer to the “HCFA/CMS 1500 Tutorial” or the ILS Provider Manual.

(2) UB-04 This billing form is used when billing for home health care, skilled nursing, and nursing home room and board. For instructions on completion of the UB-04 please refer to the Centers for Medicare and Medicaid Services website at http://www.cms.gov or the ILS Provider Manual.

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Care Management & Prior Authorization:

To obtain a prior authorization, request a referral for additional services or if you require assistance please contact Extended MLTC Member Services 855-299-6492 and press “0” to reach a Member Services department representative. Our normal business hours are Monday through Friday 8:30 AM through 8:00 PM and Saturday 10:00 AM through 6:00 PM with 24 hour on-call assistance available for emergencies.

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