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Elizabeth M. Whitehorn, Director

Managed Care Billing/Payment Issues

Billing and payment issues for patients enrolled in MCOs should be addressed as follows:

If the provider is in the network, the provider should work with the MCO.

If the provider is not in the network:

  • The provider should bill the participant's site.
  • The provider can obtain information on the participant's site by calling the MCO Member Services number or by calling the department's Provider Eligibility Inquiry Hotline at 1-800-842-1461. This number will be answered by the Automated Voice Response System. The provider should select the option to speak to a Provider Hotline representative.
  • If the site rejects the claim, the provider should bill the MCO and include a copy of the rejection from the site.
  • If the provider is not satisfied with the resolution of the claim by the MCO, the provider should file a grievance using the MCO's provider grievance process.