Provider Update

Finalization of Claims Processing

NextLevel Health ceased operations on June 30, 2020, and its Medicaid membership transitioned to Meridian Health effective July 1, 2020. NextLevel Health (NLH) is now in the final stages of closeout of its operations. As previously communicated (see NLH Provider Memo posted August 24, 2020), NextLevel Health requires all providers to meet specific claim submission and reconsideration standards to facilitate payment. Timely filing guidelines allow up to 180 days from the date of service to submit claims.. Therefore, providers who provided services for former NLH members for dates of service through June 30, 2020 had until December 31, 2020 to submit claims with date of service June 30, 2020. Now that the timely filing deadline has passed, any new claim submissions received January 1, 2021 or after will be denied.

If a provider disagrees with the claim adjudication outcome, a claim dispute must be filed. Please see the Claim Dispute Process Guidelines listed below that must be followed: Effective January 30, 2021 all claim disputes must be filed via emailing [email protected]. All claim disputes must abide by the following requirements to qualify for reconsideration:

• All claims disputes must have evidence of timely dispute being filed. Disputes must have been filed within 90 calendar days from the date of notification or denial being issued. Claim disputes should be submitted via the secure provider portal referenced above.
• Once a claim dispute is filed within timely filing guidelines, all claims affiliated with the dispute should be entered on the NLH AR research template and sent to NLH via email at [email protected]
• Only the claims submitted on the NLH AR research template spreadsheet will be considered.
• Allow at a minimum 30 days after submission for research to be conducted.
• For any status updates, please submit those inquiries and timely evidenced to [email protected].

Please email [email protected] with any questions regarding the status of your claims or claim disputes.