Frequently Asked Questions

I have heard a lot about ProviderPower, what does it exactly do?
ProviderPower is housed on our secure, HIPAA compliant website and allows access to view information about claims status, patient eligibility, and benefit plan information. It replaces the cumbersome task of managing the paper trail associated with eligibility and verification of benefits. Simply login in the morning and have access to the information you need throughout the day and well as way after five. This service will improve your office functionality, increase efficiency, and allow you to provide better service to your patients and the members of the companies we serve.
Do I need any special computer or software to access Online Provider Services?
No, an internet connection is all that is needed. Any speed and any ISP service can get you access to ProviderPower.
Does it cost anything?
No, it is offered by MAA to enhance your ability to provide services to your patients and our members.
How current is the information?
The claims status information and employee eligibility is updated nightly.
Is the information secure?
The patient information and your profile are managed in a system, which meets the requirements set forth by HIPAA for Privacy and Security of Personal Health Information.
Do I need special training to use the system?
No, most users are able to successfully navigate the user-friendly system by clicking on the menu items.
How do I sign up for ProviderPower?
  1. SIGN UP
    To access these online services go to www.maa-tpa.com and click on the tab marked Provider Services. Alternatively, go to http://secure.healthx.com/provider.asp Once there, click on PROVIDER SIGNUP or if on MAA online click on ProviderPower and follow the simple instructions to complete the form as it relates to you and your practice. Please be sure to include your email address.
  2. CREATE YOUR OWN USER NAME and PASSWORD
    Use a name and password that only you will know. A security question is offered if your password is misplaced or forgotten.
  3. SIGN IN and USE THE SYSTEM
    Once we have received your information we will review and approve your request to view claims and verify patient eligibility. You will be notified of the approval at the email address you provided in step 1.
What is your Electronic Data Interchange number?
MAA’s payer number is 37256
What EDI vendors do you accept claims from?
MAA can accept electronic professional and institutional claims from providers through WebMD, ProxyMed and THIN claims clearinghouse.

The major advantage of EDI claim submission is that it generally reduces claims processing time and provides for faster claims payment. It also reduces the amount of paper that both the provider and the payer have to manage.

How do I begin submitting claims electronically?
Please call or e-mail us at edi@maa-tpa.com to find out how you can start submitting claims to us electronically. The provider/billing service will need to work out the EDI connection with WebMD, ProxyMed, THIN, etc. MAA does not do anything to help in this process. These clearinghouses already have out payor ID and we get claims from them either through Health X or Claims Link. All this area really needs to say is the provider needs to program in our payor ID number when submitting to a clearinghouse. Where do they call and who do they talk to If you are currently a participating WebMD, ProxyMed or THIN provider, MAA’s payer number is 37256.
 
What is the Provider Verification for Claims and Eligibility Status link?
The Provider Verification link is a web-based benefits, eligibility, and claim status system.  It allows your office to make inquiries 24 hours a day.  To find the link go to the Home page or the Provider page on this website. 
What information do I need to access the Provider Verification site?
You will need to have your Provider Tax ID Number (TIN), the Employees social security number, the Patient's date of birth, and the date of service of the claim.
Is the information received from ProviderPower or the Verification link a guarantee of payment?
No, information received from MAA (either through ProviderPower, the Verification Link or on the telephone) can not ever be considered a guarantee of payment by the Plan. The eligibility information the system compiles is the most accurate data available to MAA at the time of transmission but may not reflect changes in status that are known to the employee or employer and not yet communicated to MAA.

Benefits given are a summary of plan benefits and are subject to all plan provisions, terms, and exclusions. Because diagnosis heavily affects the benefits of claims, benefits can't be assured in advance. Claims can only be considered upon receipt of an itemized statement of charges, including appropriate codes for diagnosis and procedures. 

What do I need to do if one of our patients needs an outpatient surgery or procedure?
Call Mutual Assurance (800.825.3540 or 405.848.1975) and ask for the certification or UR department. They will advise you if the proposed procedure requires certification under the terms of the Plan.
When does a patient need a Certification?
For hospital admissions or surgery approvals, Mutual Assurance (800-825-3540 or 405-848-1975) must be called within 72hrs following such admission. It is recommended that such notification be given at least three (3) days prior to any hospital admission; however, you are not required to do so except for those services listed in the Case Management section. Non-ERISA groups are required to call prior to elective surgeries and within 48hrs of an emergent admission or penalties may be applied according to their Plan benefit.
What is case management and how is the process initiated?
In cases where the patient's condition is expected to be or is of a serious nature, Mutual Assurance will arrange for review and/or Case Management Services from a professional qualified to perform such services. Case Management is prompted by catastrophic diagnosis, multiple admissions, and/or costly medical treatment.
What is BabyLinks?
BabyLinks is an early prenatal care management designed to help promote early prenatal care and the health and well-being of the mother and baby. Enrollment occurs when the expectant mother contacts Mutual Assurance Administrators after her first MD appointment confirming her pregnancy. There is no additional cost to the member for this service. Depending on the plan, better benefits may be available by an expectant mother participating in the BabyLinks program.
How can I check to see if a doctor we are referring a patient to is a member of their PPO?
You can click here to see if the plan’s PPO is listed. If it is, you will be able to link to their web site. Please remember that MAA does not maintain these web sites and is not responsible for their content or accuracy.

If their plan’s PPO is not listed, please refer to the PPO administrative guide that was supplied to your office by the PPO to see if the doctor is a listed provider. You can also contact the PPO network directly to verify if the doctor is still a PPO provider. Be sure to identify yourself as a provider's office to get expedited service from the PPO.

How does MAA determine Reasonable and Customary (R&C) for out-of network claims?
The "Reasonable and Customary Charge" is the amount measured and determined by comparing the actual charge with the charges customarily made for similar services and supplies to individuals of similar medical conditions in the locality concerned. MAA subscribes to an independent company for usual, customary, and reasonable fees. The fees are profiled by zip code for each procedure code. This information comes from a multitude of physicians and clinics. Information has also been acquired directly from insurance companies, third party administrators, the Health Care Finance Administration, Workers’ Compensation carriers, as well as Medicare, Medicaid and Champus carriers.