For faster claims processing, we strongly encourage claims submission via electronic data interchange (EDI) or online using our secure provider portals.

Meridian’s preferred EDI clearinghouse is Availity. Electronic claims submitted from other clearinghouses will be routed to Availity prior to being sent to Meridian. The secure Availity portal can be used to submit claims, check claim status, resubmit claims, and make claim corrections.

Availity

Payer ID*: MHPIL
*Note: Providers utilizing Change Healthcare as their clearinghouse must submit with Payer ID MCCIL

Claim Types: Professional/Facility

Customer Support: 800-282-4549

Mail claims to:
Meridian Claims Department
PO Box 4020
Farmington, MO 63640-4402

If you are re-submitting a claim for a status or a correction, please indicate “Status” or “Claims Correction” on the claim.

Review the Meridian provider manual and IAMHP Comprehensive Billing Manual for a full list of claim submission guidelines, which include:

• Providers must use a standard CMS-1500 Claim Form or UB-04 Claim Form for submission of claims to Meridian, or the 837P or 837I formats if filing electronically
• Providers must use industry-standard procedure and diagnosis codes such as HCPCS, CPT, Revenue, or ICD-10, and Taxonomy codes billed in accordance with state Medicaid, as well as industry-standard guidelines, when submitting a claim to Meridian
• Claim must be original, using national or state form types as applicable. Photo or scanned copies are not accepted. The claim information must be typed, with no handwritten information other than applicable signatures.
• The standard timely filing submission of Medicaid claims must be within 180 days from the date of service.

Meridian tracks known claim processing issues and aims to share regular updates about the status of issue resolution.

Review our Claims Issues and Resolution Status web page for a list of current and completed projects.

When Meridian receives a fee schedule update or program change from HFS, we will load the change to the claim system as quickly as possible.

Review the HFS Fee Schedule and Program Changes web page to view a log of updates and the current status of claims adjustments.

Meridian partners with PaySpan to offer a solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). Using this free service, providers can take advantage of EFTs and ERAs to settle claims electronically without investing in expensive EDI software.

Following a fast online enrollment, providers are able to receive ERAs and import the information directly into practice management or patient accounting systems, eliminating the need to key remittance data off paper remittances. Download our PaySpan flyer (PDF) for additional information.

• Getting started with PaySpan
• PaySpan online login and registration

For registration assistance, contact PaySpan, Inc. at 877-331-7154.

CARCs (Claim Adjustment Reason Codes) and RARCs (Remittance Advice Remark Codes) explain why an insurance claim was denied, adjusted, or paid differently than billed. They appear on the provider’s remittance advice.

Download CARC/RARC definitions (PDF)

Providers electing to dispute the disposition or reimbursement level of a claim may do so via the Meridian secure provider portal. Submitting a claim dispute is a simple process and must be completed within 90 days of the remittance date.

• Select the claim and provide appropriate reason for the dispute
• Supporting documents can be attached (i.e., medical records, etc.)
• Attaching a completed claims dispute form (PDF) is not required but may help support the dispute
• The dispute will be reviewed by a dispute analyst
• If your original claim reimbursement is updated, you will receive a new reimbursement via the Explanation of Payment
• If your original claim reimbursement is upheld, a letter will be sent acknowledging the reason for the dispute being upheld

The secure provider portal is the preferred method for submitting a claim dispute.

Providers may submit a dispute by mail by completing the claim dispute form (PDF) and mailing it to the address listed on the form.

Navigate to the Pharmacy Disputes page for guidance on disputing a claim for pharmacy services.

When Meridian identifies an opportunity to clarify billing requirements, we aim to share helpful guidance and allow providers an opportunity to submit a corrected claim for adjusted reimbursement as appropriate within allowed resubmission timeframes.

Review our Billing Updates and Reminders page to find guidance related to common billing issues, organized by provider type.

We strongly encourage providers to familiarize themselves with the billing guidelines outlined in the Illinois Association of Medicaid Health Plans (IAMHP) Comprehensive Billing Manual.

The manual outlines billing policies and procedures common to all Medicaid managed care organizations. It also highlights procedures that are specific to each health plan. The manual is updated regularly, and our claims team collaborates with IAMHP to ensure Meridian policies are accurate.

The most current fee schedules can be accessed directly from the Illinois Department of Healthcare and Family Services.

Medicaid Reimbursement

Providers are encouraged to become familiar with the fee schedule(s) applicable to their organization to ensure correct codes and modifiers are utilized for proper reimbursement.

Providers billing for services delivered to Wellcare Meridian Dual Align (HMO D-SNP) members should consult the billing and claims resources on the Wellcare By Meridian provider resources page.

Reminder: When using the secure provider portal, providers should confirm the Wellcare Meridian health plan type is selected when completing all billing activities for Wellcare By Meridian members.