Friday, April 26, 2024, 6:56 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
THIRD PARTY LIABILITY (TPL)
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. |
Do you have to ask MIVS to research TPL non-payment?No, they do this on their own to ensure payment. |
Does the Medicaid card have all the information needed?No, you should further investigate eligibility using eligibility resources and the information provided on the card. |
For HIPP referral, who should you contact?For HIPP referral, providers should contact the Medicaid Insurance Verification Services at 1-888-289-0709 option 5, option 4. The HIPP Fax is 803-462-2580. |
How do patients learn updated information?Patients learn of updates at their enrollment anniversary dates, or you may share information with them. |
How long do you have to request a hearing for an appeal?You have 30 days to request a hearing. |
If a Health Insurance Information Referral Form (HIIRF) is completed with no documentation, will the beneficiary's TPL record be updated?No, MIVS will further investigate and draft a letterhead showing steps taken. |
If a plan doesn’t cover family planning, do we bill to Medicaid and send the EOB?Certain services are “carved out”, not covered, by the MCOs and MHNs. Those services can be billed directly to SC Medicaid. You do not need to bill to the managed care plan for a denial. |
If I have a difficult payer, do I need to complete a reasonable effort document?Yes you can. It is to show efforts made to obtain other payments from other insurers. |
If I send a HIIRF, will I see anything saying it was received?No, just wait a few days and check eligibility again. |