MHS Announces Online Claims Enhancements Including Claim Reconsideration/Informal Disputes
Date: 03/06/20
Managed Health Services (MHS) is excited to announce changes to the secure Provider Portal. These changes will enhance the ability of providers to conduct business with MHS from the convenience of their desktops seamlessly and in real time. Inside our Provider Portal you can check member eligibility, benefits and cost shares; submit claims; review payment status; and request prior authorizations. Our provider portal is your one-stop-shop location for any MHS transactions.
Skip the phone call!
Currently the Provider Portal provides the ability to check claims status, as well as submit corrected claims.
Beginning 4/3/2020, we are updating several aspects of our online Provider Portal, adding features that will simplify the provider experience.
Soon, when you log into our Provider Portal you will find the ability to submit claim reconsideration/informal disputes online. The new capabilities include:
- The ability to submit and track the status of claim reconsiderations/informal disputes online
- Expanded free text fields for reconsideration/informal dispute comments and explanations
- The ability to attach required documentation when filing a reconsideration/informal dispute
- Push notification opt in/out for reconsideration/informal dispute status changes
It is important to note that all requests submitted via the reconsideration tool will be considered an informal dispute. In addition, calling Provider Services will not pause the time frame for timely submissions for informal disputes. As such please remember the following:
- Providers do not need to call prior to submitting an online claim reconsideration/information dispute.
- Providers may include a dispute form, but it is not required, as you may include comments directly into the portal.
- Submissions must be made within 67 calendar days of the date on the Explanation of Payment (EOP).
MHS will review the information submitted and respond to the provider within 30 calendar days; however, status will be available online as the informal dispute is reviewed.
Submission of a request for claim reconsideration/informal dispute via the on-line portal is the preferred method of submitting reconsideration/informal disputes. However, providers may still submit informal disputes via mail as outlined in the MHS Provider Manual.
If a provider is not satisfied with the online claim reconsideration/informal dispute resolution, the provider may file an administrative claim appeal as outlined in the MHS Provider Manual. MHS will be moving to online appeals in late 2020.
MHS believes these updates to our Provider Portal will create a more user-friendly experience and enhance your ease of doing business with MHS.
Click here for additional information on enhanced portal services with Provider Portal screenshots.