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Illinois Harmony Medicaid Transition to MeridianHealth (Meridian) - Claim Information

Effective January 1, 2019, Harmony Health Plan and Meridian Health Plan, both WellCare companies, will become Meridian Health, a WellCare Company. This announcement is to assist providers with changes affecting current Harmony members’ 2018 and 2019 Claim Submissions, Member Eligibility, Claim Status Inquiries and Customer Service information. We would like to help your billing department get your claim submissions processed as efficiently as possible. We ask that you please use the date of service guidance below to submit any claim submission.

Date of Service Guidance

Date of Service Health Plan Name Transaction Type (CH/RP) Clearing House Payer ID Paper Claim Submissions
On or before
December 31, 2018
 Harmony, a WellCare Company Fee-for-Service
BHT06 = CH 
14163   WellCare Health Plans
Claims Department
P.O. Box 31372
Tampa, FL 33631-3372
On or before
December 31, 2018 
 Harmony, a WellCare Company Encounter
BHT06 = RP 
 59354  WellCare Health Plans
Claims Department
P.O. Box 31372
Tampa, FL 33631-3372
On or after
January 1, 2019 
MeridianHealth, a WellCare company   Both 13189  Meridian Health
1 Campus Martius
Suite 720 Detroit, MI 48226 Attn: Claims Department 

Instructions on How to Determine Correct Payer for Date of Service

  • If billing a professional submission with services spanning 2018 and 2019, to avoid rejection please split each year’s services into two separate claim submissions. Professional (837P) service date for all claim lines is located in Loop 2400 (DTP*472*from-through~) or FL-24a unshaded area on the CMS1500 02/12 paper form.
  • If billing a professional or an outpatient bill type institutional submission, please use the earliest From Date in the claim submission for the guidance outlined below. Professional (837P) earliest service date in all claim lines is located in Loop 2400 (DTP*472*from-through~) or FL-24a unshaded area on the CMS1500 02/12 paper form. Institutional statement date is located in Loop 2300 (DTP*434*from-through~) or FL-06 of the UB-04 CMS-1450 paper form.
  • If billing an institutional inpatient bill type submission, please use the Admit Date in the claim submission for the guidance outlined below. Institutional (837I) is located in Loop 2400 (DTP*435*date~) or FL-12 of the UB-04 CMS-1450 paper form.

Please Note: For fastest, most accurate processing, EDI is the preferred method.

Real-Time Connectivity

Vendor Partner Health Plan Phone Numbers
Change Healthcare
        Harmony and Meridian         1-877-363-3666, prompt 1    
Availity®         Harmony and Meridian         1-800-282-4548
TransUnion® Healthcare         Harmony         1-877-732-6853
AdminisTEP.com         Harmony         1-888-751-3271
Payerpath         Meridian         1-877-623-5706, prompt 2
SSI® Group         Meridian         1-800-880-3032, prompt 8

These services improve data interchanges, provide an innovative solution to provider requests and will be leveraged to implement other HIPAA-compliant transactions in the future:

  • Real-time eligibility and claim status information – no waiting on the phone
  • Low or no cost to the provider community
  • Increased office productivity
  • One-stop shopping-view eligibility and claim status information for all participating health insurance companies from a single website with a single login


CORRESPONDENCE

Please be aware, your billing department will need to submit to the appropriate payer to prevent submission delays. Use the same date of service logic provided on the first page to determine the correct payer to mail any paper submissions.

Health Plan & Correspondence Type Date of Service Mailing Address
Claim Payment Disputes
(Related to untimely filing, incidental procedure, unlisted procedure code)
On or before
December 31, 2018
WellCare Health Plans
Claim Payment Disputes
P.O. Box 31370
Tampa, FL 33631-3370
  On or after
January 1, 2019 
MeridianHealth
ATTN: Claims Department
1 Campus Martius, Suite 720
Detroit, MI, 48226 
Claim Appeals
(Medical) (Medical necessity, authorization denials, benefits exhausted and non-covered procedures) 
 On or before
December, 31, 2018
WellCare Health Plans
Appeals Department
P.O. Box 31368
Tampa, FL 33631-3368 
  On or after
January 1, 2019 
MeridianHealth
ATTN: Appeals Department
P.O. Box 44287
Detroit, MI, 48244 

RESOURCES

Date of Service Resource Links
On or before
December, 31, 2018
 https://www.wellcare.com/en/Illinois/Providers/Medicaid     
On or after
January 1, 2019
 https://corp.mhplan.com/en/provider/illinois/meridianhealthplan/benefits-resources/tools-resources/

ELECTRIC FUNDS TRANSFER AND ELECTRONIC REMITTANCE

There are no changes, as PaySpan® Health will continue to be the provider of Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) free solutions. If you are not already registered, create a new account by registering at www.payspanhealth.com or calling 1-877-331-7154.

OTHER PROVIDER SERVICE INQUIRIES

For eligibility/benefit information, claim status or other claims-related dispute questions you may have, please choose the appropriate provider service number below. If you have any questions regarding this message, please feel free to contact WellCare’s EDI Department at EDI-Master@wellcare.com.

Date of Service Health Plan Provider Service Phone #
On or before
December 31, 2018
 Harmony  1-800-504-2766
On or after
January 1, 2019
 MeridianHealth  1-866-606-3700

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Last Updated On: 1/8/2019