I am unable to log in to the secure section of the Provider web site. What should I do? If you have not been assigned an ID/password by your facility’s administrator, contact your administrator to request an ID/password. If you have an ID/password but are not able to log in, or if you do not know the name of the administrator at your facility, contact the Provider Services Line at 1-800-788-4005, Monday – Friday from 7:30 a.m. to 6 p.m. (Central Time).
I got to the screen where I am supposed to select an algorithm, but I am unable to make a selection. What should I do next? The algorithms are available for all age groups for members who have Medicaid coverage. If you are not able to make a selection you must contact the CMC at 1-800-424-4399. There are various reasons an algorithm may not be available for a specific member, including those that are currently in an Inpatient program or were recently in an Inpatient program.
Can I use this for all members managed by Magellan? This is available only for those members with Medicaid funding associated with their eligibility. If you attempt to use this application for a member who does not currently have this Medicaid indicator on their eligibility record you will see a “dummy” algorithm that tells you to call the CMC after you have selected a member from the member look-up section.
Can I use this for members who have Medicare or Private Insurance as their primary insurer? You will need to call to register these members rather than using this on line process. There is a question in the algorithm that asks if the members have one of these as their primary insurance, and if you answer yes to that question you will be instructed to call the CMC.
Do I need to obtain authorization for members who have Medicare primary or Private Insurance primary? Yes. We create “stand-by” authorizations for these members in the event the members have exhausted their benefit under the primary insurance.
Is it not a HIPAA violation to contact you for a member who has Medicare or Private Insurance as their primary coverage? No, since Medicaid is also an insurer for these members and Medicaid may be receiving a bill for the treatment, it is acceptable to contact us.