Tuesday, April 30, 2024, 1:38 AM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
THIRD PARTY LIABILITY (TPL)
If my third party has several addresses, which one do I choose?You would contact the company to find out which address is for your service area. |
If the beneficiary had Champus or Tri-Care and it paid 100%, why would I need to file to Medicaid?You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. |
If you know a service isn’t covered, do you still file to the other carrier?Yes, you still file to the other carrier to obtain a valid denial. Three denials should be kept on file each year. |
What do you do if monies are sent to the patient?Change them to self pay after or before service completion. |
What happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?Professional billers do not receive retro health letters. Medicaid contacts or solicits billing payments from the private health plan. |
What if a claim is created, but the beneficiary says that he/she no longer has the insurance on file?If a beneficiary no longer has the insurance policy that is seen on the Web Tool, the provider can refer the beneficiary to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the beneficiary’s third party payer information. Making a change to a policy that already exists in the Medicaid Management Information System (MMIS) takes five days. The HIIRF Form can be faxed to 803-252-0870. |
Where are the specifics for pay and chase?The specifics for pay and chase are found in Section 2 (polices) and section 3 (billing) of your provider manual. |
WEB TOOL
Are Web Tool lists separated by login?No, your lists are sharable. |
Can batches be deleted after they are sent?No. Batches cannot be deleted at this time. |
Can claims be lost via the Web Tool?Generally, they don’t get lost using the web. |