Skip to Main Content

Have questions about claims? We’ve got answers.

  • The red ink we require allows our scanners to create a "cleaner" image of claims which is easier and faster to process with data capture automation software and increases our accuracy and timeliness of claims adjudication.
  • MHN cannot accept non-standard claim forms or photocopied claims forms because those do not allow our scanners to create the clean image necessary to complete claim adjudication.
  • If you receive a rejection from MHN for this reason, you will be given details on the requirements and the need to resubmit.
  • Alternately, you can submit claims electronically to avoid this requirement.

As a facility offering Intensive Outpatient or Partial Hospitalization Program services (IOP/PHP) you may have received notice of the need to submit itemized details for the services provided and billed. You do not need to submit a dispute or appeal to provide MHN the additional information; just re-submit the claim – The additional information needed is: a breakdown of all services rendered, the costs, and all CPT or HCPCS codes.

Please review MHN’s policy regarding revenue codes for out-of-network facilities billing for IOP/PHP services below:

  • Substance Use Disorder IOP/PHP Revenue codes 905, 906, 910-913 are not payable codes for out-of-network facilities. The only payable revenue codes are 043X, 0900, 0904, 0914-0916, 0918 and 0942.
  • Mental Health IOP/PHP Revenue codes 905, 912 and 913 are the only payable revenue codes for out-of-network facilities.

If you are a contracted provider and received an overpayment /recoupment letter, please refund MHN as requested or else the funds owed may be offset against future payments.  Please do not request an offset of the overpayment because the offset process is automated. 

If you are a non-contracted provider and received an overpayment /recoupment letter, please refund MHN as requested. MHN will not offset the funds owed against future payments.

· BS

“This is not a denial. This is a request for a detailed itemized bill. This is not a request for medical records. Please resubmit an itemized, original UB04 claim form that: (a) provides details of the member's program for each date of service; (b) includes specific clinical services provided, including the revenue code and corresponding most specific HCPCS/CPT for each service; (c) contains the appropriate Type of Bill for the procedure rendered and (d) a breakdown of the services for each day; not the itemization of the higher level of care by date. The MHN website is available to you at www.mhn.com/providers/claims/claims-submission if you need billing assistance.”

What does this mean?:  It means that MHN needs more information to determine if the claim is payable. You do not need to submit a dispute or appeal to provide MHN the additional information; just re-submit the claim – The additional information needed is: a breakdown of all services rendered, the costs, and all CPT or HCPCS codes.

· IG

“Please resubmit claim with appropriate Type of Bill and/or Procedure/Revenue code combination for the services rendered. See www.mhn.com/provider/start.do for billing instructions.”

What does this mean?: It means that MHN needs the claim to be corrected to determine if the claim is payable. You do not need to submit a dispute or appeal to provide MHN the corrected claim; just re-submit the claim – The claim that you submitted has a Type of Bill and Procedure/Revenue code combination that doesn’t match.   Consider reviewing the authorization that you received from MHN to determine which Bill Type and Procedure/Rev Code combination is necessary. For example, if the authorization is for Mental Health services, the Bill Type should not indicate an SUD facility or location.

· DD

“Explanation of Medicare Benefit statement required.”

What does this mean?: It means that the member has Medicare coverage primary to MHN and MHN needs the EOB from the Medicare carrier to determine if the claim is payable (and how much).

What if the member has only Medicare Part A but MHN is asking for the Medicare EOB for outpatient services not covered by Medicare Part A?: The member can both complete and return the COB verification form sent to them by MHN –OR- Call MHN to provide the COB information verbally.

· EB

“Your claim has been received and it is being internally forwarded to the proper department within Health Net/Centene for processing. The original received date will be honored. All claims received are tracked to regulatory turnaround times and applicable interest payment guidelines.”

What does this mean?: It means that MHN received the claim but forwarded it to Health Net, California Health and Wellness, or Centene to process it under the medical benefit.

What if Health Net/California Health and Wellness/Centene is saying they haven’t received it? : If it has been more than 30 days, submit the claim directly to Health Net/California Health and Wellness/Centene – OR - call MHN to request a re-forwarding of the claim.

·  BC

“Not a covered benefit of the plan”

What does this mean?: It means that MHN has determined that the service is not covered, such as no out of network benefits, not covered services, or excluded diagnoses. If you disagree with MHN’s determination, you can submit an appeal or dispute and MHN will research and determine if the denial is accurate. 

· EG

“MHN is responsible for Behavioral Health Services only.”

What does this mean?:  It means that the claim you submitted was for services that are not considered Behavioral Health and therefore not MHN’s responsibility. Examples include, dental services, vision services, medical services, personal care items, or podiatry services. Additionally, Physical, Speech, and Occupational Therapy performed by a non-behavioral health provider is also not considered a behavioral health service.

· BB

“Member not eligible prior to effective date.”

What does this mean?:  It means that the date of service on the claim was before the member was eligible for coverage with us. Consider researching whether the member had coverage with another plan for the date of service. However, if you disagree with MHN’s determination, you can submit an appeal or dispute and MHN will research and determine if the denial is accurate.

· BR

“Please send a copy of the primary carrier's EOB”

What does this mean?:  It means that MHN believes the member has other coverage through another plan that is primarily responsible for the service you provided. Please resubmit your claim with the primary plan’s Explanation of Benefits (EOB). If the member does not have other coverage that is primarily responsible for the service you provided, please instruct the member to contact MHN to correct the information we have on file.

· TC

“Facility/provider not contracted for billed procedure.”

What does this mean?:  It means the service billed is not included in the contract with the facility or provider and therefore is not payable. If you disagree with MHN’s determination, you can submit an appeal or dispute and MHN will research and determine if the denial is accurate. If you want to add the service to your contract, please contact MHN Provider Relations at 1-844-966-0298 during standard business hours.

·  AE

“Actual visits exceed authorized visits”

What does this mean?:  It means the MHN approval does not cover the number of visits on the claim you billed. If you disagree with MHN’s determination, you can submit an appeal or dispute and MHN will research and determine if the denial of those additional visits is accurate.

· NP

“No out of network benefits available for service rendered”

What does this mean?:  It means the member does not have a policy with out of network benefits and is limited to services provided by a MHN contracted provider (unless it was an emergency). If you disagree with MHN’s determination, you can submit an appeal or dispute and MHN will research and determine if the denial is accurate.

· B2

“This is not a denial. Provider please resubmit claim with complete medical records for full length of stay including Initial Summary, Evaluations, Treatment Plan, Individual and Group Notes and Discharge Summary. MEDICAL RECORDS SUBMITTED SHOULD INCLUDE ALL APPLICABLE RELEASES OF INFORMATION. No action is required from the member at this time.”

What does this mean?:  It means the service (or services) has not be reviewed for medical necessity and MHN requires medical records to determine coverage.

· HF

“HCPC code not accepted by this administrator/payer”

What does this mean?:  It means that MHN does not accepted the HCPCS code under the plan your patient is enrolled.

·  VA, VB, VD, VE, VF, VG, VH, VI, VJ,  VK, VL, VM, VN,VO,VP, VQ,VR,VS, VT.VW, VY

What does this mean?:  It means that a code review was conducted on your claim. Please review the details in the remark code description to determine your next steps.  If you disagree with MHN’s determination, you can submit an appeal or dispute and MHN will research and determine if the adjudication is accurate.

Keep checking here for new/additional FAQs!