Billing and Payments

When billing for services rendered to Meridian MMP members, providers must use the most current Medicare-approved coding (ICD-10, CPT, HCPCS, etc.) available.

Claims must be submitted using the proper claim form/format, e.g., for paper claims, submit a CMS1500 or UB04 and for an electronically submitted claim, submit in approved ANSI/ HIPAA format. It is recommended that claims be submitted as if they are being billed to Medicare fee-for-service. Meridian will apply Medicare benefits and, when applicable, Medicaid benefits.

Billing Requirements

• Providers must use a standard CMS 1500 Claim Form or UB-04 Claim Form for submission of claims 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
• Taxonomy code must be included on ALL claims
• Claims for Meridian MMP members must be submitted within 180 days from the end of the date of service. Failure to submit claims data within the prescribed time period may result in payment delay or denial. This guidance is in accordance with CMS’ expectations concerning timely submission of claims/encounter data by the MMP

Claims Mailing Requirements

Beginning January 1, 2021, Submit all initial claims for payment to:
Attn: Meridian MMP Claims Department Meridian
P.O. Box 3060 Farmington, MO 63640

If you are resubmitting a claim for a status or a correction, please indicate the claim number of the claim that is being corrected and a code in the appropriate field indicating it is a corrected claim.

Explanation of Payments (EOP)

Meridian sends providers two remittance vouchers as a method of EOB.

When to Bill an Enrollee

All providers must adhere to federal protection laws and are prohibited from balance billing any enrollee beyond the enrollee’s cost sharing, if applicable. You may not balance bill for services and supplies furnished to Meridian MMP members. Any difference between what you bill and what Meridian pays cannot be billed to the member. An enrollee may be billed ONLY when the enrollee knowingly agrees to receive noncovered services under Meridian MMP.

• The provider MUST notify the enrollee in advance that the charges will not be covered under the program.
• The provider MUST have the enrollee sign a statement agreeing to pay for the services and place the document in the enrollee’s medical record. 

Electronic Claims Submission

Meridian is currently accepting electronic claims using the following payer ID information. Providers are responsible for ensuring that they receive a confirmation file for claims submitted via EDI. Effective January 1, 2021, the Payor ID is MHPIL.

Payment to Non-Contracted Providers

Meridian will make timely and reasonable payment on behalf of or to the member for the following services if obtained by an out-of-network provider in accordance with 422.100(b):

• Ambulance services dispatched through 911 or its local equivalent
• Emergency and urgently needed services
• Maintenance and post-stabilization care services
• Renal dialysis services provided while the member was temporarily outside the plan‘s service area
• Services for which coverage has been denied by Meridian and found (upon appeal) to be services the member was entitled to have furnished, or paid for, by Meridian 

When billing for services rendered to Meridian MMP members, providers must use the most current Medicare-approved coding (ICD-10, CPT, HCPCS, etc.) available.

Claims must be submitted using the proper claim form/format, e.g., for paper claims, submit a CMS1500 or UB04 and for an electronically submitted claim, submit in approved ANSI/ HIPAA format. It is recommended that claims be submitted as if they are being billed to Medicare fee-for-service. Meridian will apply Medicare benefits and, when applicable, Medicaid benefits.

Billing Requirements

• Providers must use a standard CMS 1500 Claim Form or UB-04 Claim Form for submission of claims 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
• Taxonomy code must be included on ALL claims
• Claims for Meridian MMP members must be submitted within 180 days from the end of the date of service. Failure to submit claims data within the prescribed time period may result in payment delay or denial. This guidance is in accordance with CMS’ expectations concerning timely submission of claims/encounter data by the MMP

Claims Mailing Requirements

Beginning January 1, 2021, Submit all initial claims for payment to:
Attn: Meridian MMP Claims Department Meridian
P.O. Box 3060 Farmington, MO 63640

If you are resubmitting a claim for a status or a correction, please indicate the claim number of the claim that is being corrected and a code in the appropriate field indicating it is a corrected claim.

Explanation of Payments (EOP)

Meridian sends providers two remittance vouchers as a method of EOB.

When to Bill an Enrollee

All providers must adhere to federal protection laws and are prohibited from balance billing any enrollee beyond the enrollee’s cost sharing, if applicable. You may not balance bill for services and supplies furnished to Meridian MMP members. Any difference between what you bill and what Meridian pays cannot be billed to the member. An enrollee may be billed ONLY when the enrollee knowingly agrees to receive noncovered services under Meridian MMP.

• The provider MUST notify the enrollee in advance that the charges will not be covered under the program.
• The provider MUST have the enrollee sign a statement agreeing to pay for the services and place the document in the enrollee’s medical record. 

Electronic Claims Submission

Meridian is currently accepting electronic claims using the following payer ID information. Providers are responsible for ensuring that they receive a confirmation file for claims submitted via EDI. Effective January 1, 2021, the Payor ID is MHPIL.

Payment to Non-Contracted Providers

Meridian will make timely and reasonable payment on behalf of or to the member for the following services if obtained by an out-of-network provider in accordance with 422.100(b):

• Ambulance services dispatched through 911 or its local equivalent
• Emergency and urgently needed services
• Maintenance and post-stabilization care services
• Renal dialysis services provided while the member was temporarily outside the plan‘s service area
• Services for which coverage has been denied by Meridian and found (upon appeal) to be services the member was entitled to have furnished, or paid for, by Meridian