Clinical Overview. Presented by: Rebecca Procopio, Clinical Director Foley Nash, Children s System Administrator

Transcription

1 Clinical Overview Presented by: Rebecca Procopio, Clinical Director Foley Nash, Children s System Administrator

2 Medical Necessity Guidelines Mental Health Services What are medical necessity guidelines? Developed specifically for Louisiana Behavioral Health Partnership Based on: Louisiana Medicaid definition of medically necessary services Louisiana Register and Administrative Code regarding inpatient services Service Definition Manual for all other levels of care and services Magellan Medical Necessity Criteria No cost to providers 2

3 Medical Necessity Guidelines Addiction Services American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition-Revised (ASAM-PPC-2R) Utilized for all addiction services Six Dimensions Intoxication/Withdrawal Biomedical Emotional/Behavioral/Cognitive Readiness to Change Relapse Recovery Environment How to order ASAM criteria: Website: 3

4 Authorization Process Beginning 3/1/12 (New Members) Waiver Initial Authorization Subsequent Authorizations 1915i members CSoC members (1915c) Must complete Independent Evaluation to qualify. Independent Plan of Care (POC) developed and submitted for approval. Good for 3 months Eligibility Determined by independent CANS assessment. POC completed by wraparound facilitator. Plan is approved and authorized by Magellan for six months. Individual services submitted based on POC. Authorization good for 3 months. POC must be updated at least annually. Revised POC is authorized for six months. 4

5 Authorization Process Beginning 3/1/12 (New Members) Level of Care Initial Authorization Subsequent Reviews Inpatient, Psych Inpatient SUD PRTF, TGH, TFC, NMGH Residential SUD Phone or Online Case Logix 2 days Detox 1-3 days Rehab 3-5 days Phone Up to 5 days Detox 1-2 days Rehab 3-5 days days 7-28 days Detox 1-3 days Rehab 7-14 days Detox 1-2 days Rehab Up to 10 days IOP SUD 2 months Up to 1 month 5

6 Authorization Process Beginning 3/1/12 (New Members) Level of Care Initial Authorization Subsequent Reviews ACT 2 months Up to 3 months ICM 2 months Up to 3 months MST FFT Homebuilders Up to 244 units (good for five months) Up to 32 hours (good for three months) Up to 60 hours (good for six weeks) Up to 50 units (good for 30 days) Must be requested by the network provider Up to 12 hours (good for one month) Up to 10 hours (good for two weeks) 6

7 Authorization Process Beginning 3/1/12 (New Members) Level of Care Initial Authorization Subsequent Reviews PSR CPST Crisis Intervention Outpatient 3 months Units based on categorical need (Hi, Med, Lo) 3 months Units based on category Pass-through first 6 hours Registration and passthrough for: 24 sessions (hours) per member for therapy; 12 sessions (15 minutes) for medication management 3 months Units based on categorical need (Hi, Med, Lo) 3 months Units based on category Up to 66 hours for next 14 days Treatment Request Form (TRF) submitted to request up to 24 sessions of therapy or 12 sessions of medication management Neuropsych and Psych Testing Prior authorization required Prior authorization required 7

8 Transition Members in Treatment Prior to 3/1/12 Level of Care Inpatient, Psych Inpatient and Residential, Detox PRTF, TGH, TFC, and NMGH Process Acute care: Discharge/Transition Planning. On March 6 will begin authorization reviews. State hospitals: discharge/transition planning; no authorizations. Discharge/transition planning. On March 6 will begin authorization reviews. Magellan will contact facilities to begin authorization process on March 1. Residential Rehab SUD Discharge/transition planning. On March 6 will begin authorization reviews. SUD at PHP and IOP MST, FFT, Homebuilders Magellan will contact facilities to begin authorization process on March 1. No authorization required unless extension requested. 8

9 Transition Members in Treatment Prior to 3/1/12 Level of Care ACT and ICM Process Up to 30-day transition. Will do initial review during month of March. Outpatient Begins pass-through process on March 1, 2012 PSR, CPST, and Crisis Intervention Auth end Feb. 29. Based on category of LON (High, Med, Low), will be reimbursed at similar level until first authorization begins or POC is completed, whichever comes first. First authorization will be staggered from March 15 through June 30. See next slide for details. 9

10 1915i Transition Review Schedule Initial Authorization Date of Call Birthdate March 19-30, 2012 June 1-June 30 April 2-13, 2012 July 1 July 31 April 16-27, 2012 August 1 August 31 April 30-May 11, 2012 September 1 September 30 May 14-25, 2012 October 1 October 31 May 29-June 8, 2012 November 1 December 15 June 11-22, 2012 December 16 January 31 June 25-July 6, 2012 February 1 February 29 10

11 Transition Scheduling Prior to first review, reimbursement will continue at similar level to what provider is receiving prior to March 1 Reimbursement determined by category (Hi, Med, Lo) of member During first two weeks of March, Magellan will contact rehab provider to set up hourly call to review for authorization Average of four reviews per hour Will schedule from March 19 through June 30 At first review, will do a medical necessity review to determine if member s condition warrants service request. If considered medically necessary, services will be authorized based on categorical need of member Independent evaluation will determine new categorical need of member 11

12 1915i Plan of Care Schedule and Process Determination of eligibility determined by independent evaluator Independent treatment planner (who can be same person) completes Plan of Care (POC) Participants of POC include: treatment planner, providers, PCP, member, family members, and other individuals requested by member POC must be completed and submitted by member s birthdate for transition members. Future POCs will need to be completed within 90 days of birthdate Authorization of services based on POC. Good for three months Additional authorization of services via submission of service requests POC must be revised at least annually Independent evaluation and POC will be rolled out in parallel with transition authorization schedule 12

13 1915i Transition Review Schedule Date of Call March 19-30, 2012 April 2-13, 2012 April 16-27, 2012 April 30-May 11, 2012 May 14-25, 2012 Birthdate June 1-June 30 (auth good until birthday) July 1 July 31 (auth good until birthday) August 1 August 31 (auth good until birthday) September 1 September 30 (auth good until birthday) October 1 October 31 (auth good until birthday) May 29-June 8, 2012 November 1 December 15 (first auth 3 months; next one is good until birthday) June 11-22, 2012 December 16 January 31 (first auth 3 months; next one is good until birthday) June 25-July 6, 2012 February 1 February 29 (first auth 3 months; next one is good until birthday) 13

14 1915i Treatment Plan Schedule for Birthdays March through May Month of Birthday Evaluation and POC due by: Initial Authorization March May 15 May 30 April June 1 June 15 May June 15 June 30 Burden to member to have two 1915i evaluations in short timeframe 14

15 Certification of Need Process Required for Medicaid members under 21 admitted to inpatient psychiatric facilities or to psychiatric residential treatment facilities. An independent team (not contracted or employed by treating facility) is required to complete the Certification of need. Complete regulations and workflow will be provided to facilities prior to March 1. 15

16 Transition Coordinated System of Care (CSoC) Prior to March 1 Collaborative protocols with state agencies to outline referral, authorization, planning and child and family team processes. Phased-in capacity plan across CSoC implementation regions across first 15 months (see next slide) Child and Adolescent Needs and Strengths will be completed for children currently in a facility program to determine initial eligibility 16

17 CSoC Phase I Implementation Region- (5 WAAs and 5 FSOs) Rollout Period Enrolled in WAA/FSO March 1, 2012 May 31, June 1, 2012 August 31, September 1, 2012 November 30, December 1, 2012 February 28, March 1, May 31,

18 Pathway to Services for Youth Returning from Residential Care Data has been gathered from all facilities relative to 29 topic areas with 6 sub areas for each child/youth Data has been reviewed and stratified Priority has been established for youth who come from regions that are implementing Coordinated System of Care (CSoC) Further sort to identify 40 youth for each of the 5 implementing areas CANS assessment will be administered to all youth in residential care who do not have a discharge date within 30 days After final sort, youth to be referred to FSO, WAA and IA WAA wraparound facilitators will coordinate the development of a plan of care Linkage with services will be determined by the plan and coordinated through the WAA 18

19 CSoC Screening and Authorization Post March 1 Screening Brief CANS is completed by Magellan if risk is indicated by provider or Magellan Member Services If score positively, a referral to an Independent Assessor (IA) for a Comprehensive CANS Assessment is made for final CSoC eligibility determination Authorization Initial authorization will be made for the plan of care development and completion of the Independent CANS Assessment Once POC is completed and CANS validates CSoC eligibility, plan is reviewed and services as outlined in the plan will be authorized for a maximum of six months NOTE: If in a non-implementation region, Magellan Recovery Care Management will take on POC development process 19

20 CSoC Plan of Care Post March 1 Plan of Care (POC) Simultaneous to referral to an IA, a referral to Wraparound Agency (WAA) and Family Support Organization (FSO) is made to begin POC development process. Parent/Guardian is engaged Initiate formation of a Child and Family Team (CFT) to include child, family, any state agency representatives and natural supports The POC should then be completed through the collaborative CFT by doing the following: Completion of a strengths discovery Identification and prioritization of child and family needs Identification of service options connected to each prioritized need Involved State Agencies (DCFS, OJJ and/or DOE) PCP and any other involved specialist should be included in plan development 20

21 Screening for 1915i Provider contacts Magellan for authorization Magellan will inquire about eligibility Member referred directly to provider (outpatient) Provider training on four categories of eligibility Clinical Advisor with reportable fields Claims analysis of diagnoses Treatment record reviews Member contacts Magellan for referral Will not ask directly Will refer to care manager as needed 21

22 Special Health Care Needs Members (excluding 1915i and CSoC) Categories IV drug use Pregnant substance abuse Substance-using women with dependent children Co-occurring disorders Children in contact with OJJ, DCFS, and/or DOE Plan of Care (required by provider) Developed in collaboration with PCP (if not available or willing, then inform PCP of final plan) Member participation Parent or guardian participation in the case of children In consultation with any specialists caring for member In consultation with any state agency (OJJ, DCFS and/or DOE) sharing responsibility for children Screening (next slide) 22

23 Special Health Care Needs Members (non- 1915i/CSoC) Screening Provider contacts Magellan for authorization Magellan inquire if the member falls into any of the Special Needs categories Member referred directly to provider (outpatient) Provider training on categories of eligibility Clinical Advisor with reportable fields that will flag Magellan if screening is needed Claims analysis of diagnoses Treatment record reviews Member contacts Magellan Will ask directly about involvement with child-serving agencies Will not ask directly about other categories, but if member volunteers information will forward to care manager 23

24 LBHP OBH Certification Presented by: Rusty Semon, State of Louisiana

25 Definitions Certification The process used by the Office of Behavioral Health to document a provider's compliance with specific requirements (Statutory, Regulatory or OBH required) for contracting with Magellan as a managed care provider. Credentialing Process performed by Magellan to review a practitioner s or organization s credentials, e.g., training, experience, or demonstrated ability, for the purpose of determining if criteria for clinical privileging are met. Contracting Negotiation of a legal agreement between a Magellan and an organization or individual, which specifies rates, performance covenants, the relationship among the parties, schedule of benefits and other pertinent conditions. 25

26 Individual Certification Requirements 1. Individuals credentialing or applying for credentialing as individual providers are required to complete and submit an individual certification application. Attestations Criminal convictions, malpractice, withdrawal or disciplinary action from Medicare, Medicaid, other health care programs, true/accurate/complete disclosure of required information. 2. Licensed Staff - LPC, LCSW, LMFT providing addiction services Must successfully complete either the ADC, AADC or EMAC exams within 120 days of OBH certification. (After July 1, 2012, all licensed practitioners providing addiction services will be required to have successfully completed the ADC, AADC or MAC prior to providing services.) For information on ADC, AADC testing dates, locations, instructions contact LASACT at

27 Organizational Certification Requirements 1. All organizations credentialed or applying for credentialing by Magellan will be required to submit an Organizational Certification Application to OBH. 2. Organizations licensed, accredited, and Evidence-Based Practices monitored by a proprietary EBP entity to accepted fidelity standards will be Deemed certified by OBH. E.g., OBH / LGE Clinic, MHR Agency, EBP (MST, FFT, Homebuilders, ACT), LEA, PRTF, TGH. 3. Organizations providing Parent Support and Training, Youth Support and Training, Independent Living / Skills Building, Short Term Respite, Crisis Stabilization. (1915c, 1915b(3), Non-Medicaid) Curriculum approved by OBH. 27

28 Organizational Certification Requirements continued 4. Organizations providing Psychosocial Rehabilitation, Community Psychiatric Support and Treatment, and Crisis Intervention. (EPSDT SPA and 1915i) Non-licensed staff within organizations Deemed certified are not required to complete the standardized basic training. Non-licensed staff in organizations not Deemed certified must complete the standardized basic training program approved by OBH and located on Magellan s Achieve Learning Management Site Completion of required training within 90 days of OBH certification approval or the employee s date of hire. 28

29 Certification Requirements Criminal background checks are required of all staff serving youth or adults. CBC Application forms - Complete all applicant (employee) and agency (new provider) information and mail to P.O. Box 66614, Mail Slip A-6, Baton Rouge, LA, with payment of $26 per individual application. OR, register online at to gain access to the website for criminal background checks. If provider receives notification that fingerprints are needed to further process the background check, fingerprints must be mailed or hand-delivered to State Police along with a copy of the letter from the State Police requesting such. 29

30 Certification Application Process 1. Download Individual or Organizational application from LBHP SMO Procurement Library. 2. Complete the sections of the application applicable to the services you intend to provide (Individual Provider) or applicable to your organization. 3. Submit completed application (preferably electronic format) to the LBHP OBH Certification section. 4. LBHP OBH Certification section will communicate decision for certification to both you and Magellan. Failure to complete the requirements identified for certification may result in denial for certification or your being required to re-submit a completed, revised application. 30

31 LBHP OBH Certification Contact Information Call: Fax: Jill Farr, Lillie Dunn, Kenneth Saucier, Shirley Olivieri-Mathies, Diane Leonard 31

32 OBH Certification Resources Download LBHP Certification Application: Technical Assistance: Phone: (225) Fax: (225) Criminal Background Check: Application - Registration online - Providers of Addictions Service: LA-ADRA (225) LASACT (225) Magellan Achieve LMS Website: 32

33 Quality Presented by: Barbara Dunn Director, Program Innovation and Outcomes

34 Quality Improvement (QI) Promoting Quality through Partnership Our purpose is to promote quality through collaboration and partnership. We will achieve this by assigning trained and skilled clinical reviewers to: Provide providers with individualized technical assistance and training Improve provider quality through established indicators and outcomes measures Show providers how to use data outcomes, record review findings and provider profile results to improve quality Work collaboratively with providers on the development of realistic action plans when indicated 34

35 Provider Voice and Participation in Committees Magellan is committed to promoting stakeholder voice in the design and development of our quality program. Design and development occur primarily through our LA Care Management Center QI committee structure, As stakeholders, providers are invited to participate in committees. Quality Assurance/Performance Improvement Committee Utilization Management Committee Member Services Committee Regional Network Credentialing Committee Family, Member, Stakeholder Advisory Committee Race and Equity Committee 35

36 Annual Provider Satisfaction Survey Sample: All providers with one claim or authorization during the six-month survey period, typically January - June Administration: Distribute via and mail (if needed); return via mail, electronic submission, fax or mail Reporting: To DHH OBH Magellan QI will analyze through the use of: Frequency statistics Comparative analysis across administrations Key driver analysis For review and follow-up by stakeholders via the QI Committee Structure 36

37 Clinical Practice Guidelines (CPGs) Magellan adopts CPGs based on sound scientific evidence, clinical best practices and member needs. Magellan requires all of its providers to be familiar with these CPGs. A link to Magellan s CPGs is available through Magellan Adopted Clinical Practice Guidelines Acute Stress Disorder & Post-Traumatic Stress Disorder ADHD Autism Bipolar Disorder Depression Eating Disorders Generalized Anxiety Disorder Managing Suicidal Patients Obesity Obsessive-Compulsive Disorder Panic Disorder Schizophrenia Substance Use Disorders 37

38 Clinical Practice Guidelines (CPGs) Each year Louisiana QI Department clinical reviewers will audit provider compliance against three CPGs. In 2012, clinical reviewers will review for compliance with the following CPGs: Either Schizophrenia or Depression (to be determined) Substance Use Disorder ADHD (children and adolescents) 38

39 Other Review Activities In addition to reviews for compliance with CPGs, Louisiana QI Department clinical reviewers will review provider program compliance through use of the following tools: Magellan s Public Sector Treatment Record Review Tool Quarterly chart reviews for members served under the SED waiver Monitoring Tool Specific to the WAA All treatment record review tools will be available through 39

40 Overview of Outcomes and Profile Continue to meet federal and state reporting requirements New measures (state requirements) e.g., CANS Increased transparency regarding system performance (dashboards, regional reports, special topics) Development with stakeholders of "dashboards" and other reports 40

41 Outcomes-Based Reporting Meet Federal and State Reporting Requirements National Outcomes Measurement System (NOMS/URS) Treatment Episode Data Set (TEDS) Waivers and Block Grants Outcome Tools in Clinical Advisor Child and Adolescent Needs and Strengths (CANS) Level of Care Utilization System (LOCUS) Addiction Severity Index (ASI) / Comprehensive Adolescent Severity Index (CASI) Profiles Youth and Adult Providers Regions (LGE/WAA) Eligibility Categories System Involvement Evidence-Based Fidelity ACT, MST, HFW 41

42 Sample Assessment CANS on Website 42

43 Profiling: Provider, WAA, LGE, SMO Alignment with quality and outcomes measures Transparency and accountability Work toward systems dashboards with stakeholders Access to own data with comparison to all providers within type Drill down to individual level data Download own data into Excel Use the information for Quality Improvement Activities Technical assistance on use of data Webinars How to understand reports How to use for Quality Improvement Activities 43

44 Outcomes and Provider Profiles: Sample 44

45 Profile Breakouts and Measures Child Profile Mental Health Inpatient Youth Substance Use Inpatient and Rehab Outpatient Youth Residential Treatment CSoC (WAA/Region) SMO Adult Profile Mental Health Inpatient Adult Substance Use Inpatient and Rehab Outpatient Adult 1915i (Region) SMO 45

46 Profile Measures: All Breakouts Demographics Consumers served by provider - unique count Age by groupings (0-5; 6-12; 13-17; 18-21; 22-64; 64+) Gender Race/ethnicity Work/school status Youth IEP (0<6, 6-12; 13-17; 18-21) Housing/residency status Youth placed in restrictive settings outside their home Youth CYA involvement Criminal/juvenile justice involvement 46

47 Profile Measures Utilization Management Services by LOC, Services/1000 MH/SA Inpt Admits, Admits/1000 for outp ALOS or units, ALOS or units by Dx Cat MH/SA AFU 7 Days, 30 Days MH Readmission 30 Days, 90 Days, Readmission by Dx group SA Readmission 45 Days, Readmission by COD Emergency Dept usage # and #/1000 Crisis service utilization, Services/1000 Cost per person, served per month Discharge type Access First appt within 14 days Second Appt within 14 days Pharmacy (0-5; 6-12; 13-17; 18-21; 22-64; 64+) Consumers prescribed psychotropic medications Consumers prescribed duplicative medications Poly pharmacy (3 or more) Clinical Practice Guideline (CPG) pharmacy High Risk High Risk % Pharm CPGs Community Tenure 47

48 Profile Measures Administrative and Accountability Denied Claims Complaints Undup Member, Complaints/1000 Quality of Care Concerns, Quality of Care Concerns/1000 Adverse Incidents, AI/1000, AI by type Restrictive interventions (seclusion and restraint) Family and Peer Services Use of family services Use of youth support services Use of peer support services Peer specialists engaged in service, Peer specialist per clients served Clinical Quality and Outcomes Evidence-Based Practices, EBP Fidelity Clinician ratings CANS by domains, show improved functioning Clinician ratings LOCUS by dimensions and level, show improved functioning WrapAround Wrap-around plans, youth in wraparound Youth screened, identified as at-risk and referred to wrap-around agency Natural supports vs claims paid services 48

49 Profile Measures Client Surveys Survey #, response rate Easy/timely access to services and providers, Client/family involvement and choice in treatment planning Satisfaction quality, outcomes, and coordination of services provided Improved functioning, Reduced symptom severity Improved quality of life Clinical Recordkeeping (Treatment Record Reviews) MH TRR scoring by category SA Retrospective Review scoring by category Application of Principles of Recovery and Resiliency Specific MH TRR indicators Specific SA Retrospective Review indicators Linkage with Primary Care Physicians Coordination of Care scores from TRR 49

50 Evolving the Outcomes System YEAR 1 Develop reports with existing data Establish stakeholder steering committee(s) to develop outcomes dashboards (child, adult) Sharing data with providers and getting feedback YEAR 2 Implement and refine dashboards and other reports with providers and stakeholders Implement final versions for public access 50

51 Systems Dashboard Development: Year Two Year One (Q3): Stakeholder Steering Committee Year Two: Systems Outcomes Dashboards (Child and Adult) Clinical Functional outcomes Coordination of Care Access to services Recovery and Resiliency Quality of life Accountability Safety Integrated behavioral and physical health 51

52 Provider Complaints, Comments and Compliments Magellan believes that provider input, including complaints, concerning our programs and services is a vital component of our quality program. Provide complaints, comments and compliments: Through the Magellan provider website, which is accessible by links from (click FAQs/Feedback or My Messages after secure sign-in), or By contacting the Louisiana Care Management Center Network providers will not be penalized for filing a complaint Your cooperation and assistance is expected during the investigation of member complaints, adverse incidents and quality-of-care concerns if necessary. 52

53 Appeals Presented by: Barbara Dunn Director, Program Innovation and Outcomes Presented by:

54 Definitions Adverse Determination: An admission, availability of care, continued stay or other health care service that has been reviewed by a SMO and, based upon the information provided, does not meet the requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness and the requested service is therefore denied, reduced, suspended, delayed or terminated. Adverse Action: Any decision by the SMO to deny a service authorization request or to authorize a service in an amount, duration, or scope that is less than requested. 42 CFR (c). Appeal: A request for a review of an action pursuant to 42 CFR (b). 54

55 Filing an Appeal Members, or providers acting on behalf of a member and with the member s written consent, may appeal an action. Appeals must be filed within 30 calendar days of the notice of action. Appeals may be made either orally or in writing. If the appeal is not an expedited appeal, oral requests must be followed by a written, signed appeal request. Expedited appeals must be resolved within three business days of receipt of the appeal. Standard appeals must be resolved within 14 calendar days of receipt of the appeal. 55

56 Appeal Process Notices of action sent to the member and provider state that the member can appeal Magellan s medical necessity determination. Magellan will have one level of internal appeal. The appeal decision must be made by a clinician who was not involved in the initial determination. Members cannot request a State Fair Hearing until they have exhausted Magellan s internal appeals process. If a denial is upheld at appeal, Magellan s letter of determination will instruct members on how to file for a State Fair Hearing. 56

57 Continuation of Benefits Medicaid recipients have the right to request continuation of benefits throughout the pendency of the appeal. Recipients must make a separate request for continuation of benefits. It is not assumed by the fact that they have filed an appeal. The request for continuation of benefits must be made within 10 days of the mailing of the notice of action. 57

58 Fraud, Waste and Abuse As a Magellan provider, the services you offer are subject to both federal and state laws, and contract requirements designed to prevent fraud, waste and abuse. Definitions, examples and ways to prevent fraud, waste & abuse are available on the Magellan provider website (accessible through 58

59 Fraud, Waste and Abuse The most serious violation in this category is health care fraud, which is the intentional deception or misrepresentation made by an individual, knowing that the misrepresentation could result in some unauthorized benefit to them or to others. The most common kind of health care fraud involves false statements or deliberate omission of information that is critical in the determination of authorization and payment for services. Health care fraud can result in significant monetary liabilities and, in some cases, subject the perpetrator to criminal prosecution. We have a comprehensive compliance program in place, including policies and procedures to address the prevention of fraud, waste and abuse. Magellan, in conjunction with appropriate government agencies, actively pursues all suspected cases of fraud, waste and abuse. If you think you have detected an instance of either health care fraud or medical identity theft, please contact the Magellan Special Investigations Unit (SIU). The SIU can be reached through a 24-hour Fraud Hotline at or sent to SIU@MagellanHealth.com. 59

60 Claim Submission and Tracking Presented by: Sarah Maloney, Sr. Director, Operations and Implementation Matt Hall, Sr. IT Director Tim Hebert, IT Director

61 Submitting Claims for Services Rendered Magellan should receive claims only for dates of service of March 1, 2012 and beyond. Electronic Claims Submission (for providers not submitting via the CA system): Sign in to the Magellan provider website (link accessible via or through a clearinghouse. When submitting claims electronically, use submitter ID # for all except Emdeon 837I which is submitter ID# 12X27. Paper Claims - Mailing address (for paper claims): Magellan Health Services Attention: Claim Department P.O. Box 2064 Maryland Heights, MO