What is an MPSR? An MPSR is the acronym for Member and Provider Service Representative. This department is the first point of contact for all customer service needs. The MPSR is able to identify issues that need addressed with the appropriate staff and transfer your call.
What does an MPSR do? The MPSR is available from 8:00 AM to 5:00 PM, Monday through Friday to answer procedural questions such as; how do I obtain authorization? What do I do if I need to change my address? Where do I send claims? They verify eligibility, authorizations, status claims and will request adjustments if necessary.
What telephone number do members need to call? Each county has a designated toll free telephone number. A list is provided in the provider manual and all member handbooks. Member lines are designated for members.
What telephone number do providers use? The toll free provider line is 1-877-615-8503. Providers are to use this telephone number for any questions they may have.
How can I check claim status? If you cannot find the information needed from your voucher or if you want to check claim status, you may call the provider telephone number Monday through Friday from 8:00 AM to 5:00 PM or log-in to Provider Online Services. To log-in, go to pa.carelon.com, click on “For Providers,” then click on the blue Login button or the green Register button, if this is the first time using this service.
How long should I wait until I check the status of a claim? The provider should wait at least 30 business days to check the status of a claim.
How long does it take for a claim to be adjusted? The provider should wait approximately 30 – 45 business days prior to checking on an adjustment. The MPSR’s research adjustment issues that are mailed or faxed to the engagement center in date order. The turn around time for adjustments is 10 business days.
How do I check on authorization that was requested? Contact the MPSR department by dialing the provider line.
How do I file an complaint? Contact the MPSR department by dialing the provider line.
How does a member file a complaint? Contact the MPSR department by dialing the appropriate member telephone number.