Summary: Mental Health Member Claim Submission Guidelines
Participating Providers: Services rendered from a participating network provider will be
submitted directly to MHNet.
Non-Participating Providers: When seeking services with a non participating provider, please
encourage the provider to call MHNet at the number listed on the back of your medical health
plan identification card to obtain information on how they can submit claims to MHNet.
Non-Participating Providers-Member Reimbursement: If you have received services from a
Non-Participating Provider who refuses to submit their claim(s) to MHNet for reimbursement,
and/or you have paid for the services up front and would like to submit a claim for direct
reimbursement to you, please follow the claim submission guidelines below:
· Attach a copy of the receipt confirming your payment for the MHSA care received and a
written request directing payment to be made to the subscriber. Please note that
member reimbursement will be forwarded to the subscriber's address.
· Please complete the Mental Health claim form on the following page with the information
for the member who received the services. All information on the form must be either
written on the form or included on attachments. Attachments can include but are not
limited to a copy of your member ID card and a copy of the provider's bill.
· If you attach a copy of the provider's bill, it must, at minimum, include the diagnosis
code, procedure code, date of service, charge amount, provider's name, provider's
address, and provider's tax ID number.