Claims & Appeals
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Submitting Claims
As a participating provider with Passport, you have established a contractual agreement to provide physical, behavioral and/or other long-term support services to our members. The arrangement is fee-for-service for the provision of covered healthcare services unless otherwise specified under your Participating Agreement. The rates established in your Participating Agreement are considered full payment for covered services provided. Accordingly, Passport members may not be balance billed for any remaining amounts and/or difference between what is billed, and your negotiated reimbursement rates defined in the rate exhibit of your Participating Provider Agreement.
Passport pays clean claims submitted for covered services provided to eligible members. In most cases, we pay clean claims within 30 days.
How do I submit my claims to Passport?
We recommend that you submit claims through the Electronic Data Interchange (EDI) for efficient processing and payment. We work with Change Healthcare for all EDI transactions. Use EDI Payer ID number: 66008.
Submitting electronic claims
Passport offers a direct submit/web-based claims option through Availity. This functionality is available via the provider portal on our website. There is no charge to participating providers for submitting claims through the Availity tools. Availity supports keyed entry of claims on the portal and supports secure transfer/upload of batch claim files from most practice management systems. You must register with Availity to use the service and add Passport as one of your payers. If you are not currently registered with Availity please visit www.availity.com to get connected.
Submitting paper claims
To submit paper claims, please mail to:
Passport Advantage (Claims)
PO Box 3805
Scranton, PA 18505If you have question, contact the claims department at (844) 859-6152.
Processing and payment of claims for covered services are generally made within 30 calendar days of receipt of a clean claim. For more information on claims submission and payment, please refer to the Passport provider manual.
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Submitting appeals on behalf of your patients
Providers may file appeals and/or grievances on behalf of a Passport member with the member’s written consent.
To file an appeal or grievance:
- FAX to: (562) 499-0610
- Write to us at:
Passport by Molina Healthcare
Attn: Grievance and Appeals
P.O. Box 22816
Long Beach, CA 90801-9977We will make our appeal decision and send to you in writing within 30 days of receipt of the request. Expedited appeals will be resolved within 72 hours.
A grievance on behalf of a Passport member must be filed within 60 days of the event. We resolve routing complaints immediately. However, we may need to ask you to submit additional information. In that case, you will have 14 days to get us the information. We will notify the member and/or the representative within 30 days of the grievance filing or 44 days if an extension was granted.
- FAX to: (562) 499-0610