Member Verification and Billing To ensure payment for eligible services, member eligibility should be verified before rendering care. Members are requested to present their McLaren Health Advantage identification card at each visit.
If a member does not have their McLaren Health Advantage card with them, your office can verify eligibility and coverage by calling 1-888-327-0671.
The member’s ID card will list the co-payment amount for office visits. Members are aware they are required to pay this amount and your office staff should collect that amount at each visit.
Your office can bill the patient for non-covered services when they have been informed prior to receiving the service, that it is not covered by their McLaren Health Advantage benefit. For further information on services that would not be covered, call Provider Services at 1-888-327-0671.
For most of the services you provide your patients, your office must submit the claim within 1 year of the date of service, including coordination of benefits claims. If you experience a change in your billing service, have computer problems (documented in writing) or other extenuating circumstances; please contact the Provider Services Department at 1-888-327-0671. (Negligence by an employee of the provider is not considered a valid exception.) If you must re-submit a claim, they are accepted for the following situations and must be accompanied by the following:
- Documentation that it is a re-bill or second submission
- Claims requiring special consideration (i.e., referral or coding problems, special requests or adjustment).
- Re-submitted claims for additional consideration should include all codes and charges, not just additional or corrected information. Please note on the claim that this is a re-bill for additional consideration.
After forty-five days, if you have not received your claims payment, please contact Provider Services at 1-888-327-0671 to status any outstanding claims.
Process for Submitting Claims
McLaren Health Advantage accepts both paper and electronically billed claims. If billing paper claims, follow the CMS requirements for using the CMS 1500 form and mail to: McLaren Health Advantage, PO Box 1511, Flint, MI 48501-1511
For EDI claims, McLaren Health Advantage utilizes Netwerkes as its EDI gateway clearinghouse. For information on how your office can submit electronic claims to McLaren Health Advantage, contact Netwerkes at: firstname.lastname@example.org (put MCLAREN in the subject line), or call Netwerkes at (262) 523-3600 and ask for the Payer Services team. Health Advantage’s EDI payer ID is 38338.
Contracted providers are paid according to the McLaren Health Advantage fee schedule. For information about joining McLaren Health Advantage, please contact a Provider Services Representative at 1-888-327-0671.