Thursday, June 17, 2021, 3:29 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
WEB TOOL: SUBMIT A CLAIM

Do you have to put in diagnosis codes?

If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. 

Do you have to put the last 4 digits of the zip code for Claims Entry?

Yes; you can find zip codes on the US Postal Services website: www.usps.com.  Click on Look Up a Zip Code

Do you have to submit claims through Web Tool?

No, you may use other options like hard copy or vendor/clearing house.

How do I file a replacement claim for a paid claim that is partly incorrect?

Go to the Web Tool submission page. Log in; go to claims entry/history; click on the correct batch number; click on the correct claim number; copy; click the claim type on the left; click on batch, claim; edit; scroll down to claim submission reason code; select replacement. To complete this task, you must have the original Claim Control Number (CCN).

How do I know the charge?

You can find the charge for the service in your provider manual.

How far back can you bill?

Within 12 months

How far back can you file a void?

15 - 18 months

How long will a Web Tool claim stay out as a draft?

Three months.

I cannot enter all of the characters in a procedure code or a diagnosis code. Can you help me?

Remove decimal points from the code. To start afresh, backspace to the beginning of the field or highlight the characters in the code and press delete.

If I have two separate claims for one beneficiary, do I have to enter the claim information twice on Web Tool?

Yes, you would have to submit two different claims. You can go to your submitted claim bucket and copy the claim with additional edits and changes and then resubmit it instead of rekeying two claims.