Magellan Complete Care of Virginia
The following document is a required enrollment form that must be completed, signed and returned to the MCC of VA office prior to initiation of electronic claims submission or inquiry.
1. https://mccofva.com/media/1531/ebusiness-submitter-profile-form-fill_mccva.pdf
If the link above does not work properly, please download it from here:
https://mccofva.com/ccc-plus/for-providers/provider-tools/forms/claims-forms/
If you have trouble finding the form above or have additional questions regarding their EDI enrollment, please call the Magellan eBusiness Service Center at 1-800-424-4524.
Magellan Complete Care of Virginia
Section 1
Please enter your Business Name and Tax ID
Section 2
Please complete this section with your Demographic and Contact information
Section 3
Please select 837P if you submit Professional Claims (CMS 1500 if done by paper)
Please select 837I if you submit Institutional Claims (UB 04 if done by paper)
Section 4
Please skip this section it is simply advising you of your responsibility to obtain and review all electronic reports to ensure receipt of claims.
Section 5
The option for SFTP should be checked. If a check box is not available on the form, please place a checkmark next to that section after printing.
Please list the individuals who will be accessing Magellan Complete Care of Virginia systems. Since you will be sending via SFTP, you only need to list one individual.
Section 6
Please Print Name, Position and Date, then sign this document
Submitting your Forms
It is recommended that you keep a copy of the form you will be submitting for your records. Email the form reflecting original signature to:
It is very important that you complete and return the entire enrollment document. Incomplete forms will not be processed and will be returned to the submitter.
Waiting for a Response
Once the enrollment document has been received, they will begin processing. Processing will take approximately one to two weeks from the date of receipt.
After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned form is received after two weeks, please please call the Magellan eBusiness Service Center at 1-800-424-4524.
Testing
Once you have received your Submitter ID and Password from Beacon Magellan, please call the ClaimShuttle Support Team at 602-439-2525 and set an appointment for a Mailbox setup and Test Transmission.
Please have at least 5 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.