Sunday, July 14, 2024, 12:47 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

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.

Can I check claim status on the Web Tool?

Yes. Key in the NPI or provider ID number and the recipient ID number and press submit.

Can I do a span date on the Web Tool?

Yes, by entering in information in the to and from fields.

Can we find edit codes on the Web Tool?

No, however the edit code listing is found in Appendix 1 of your provider manual.

Can Web Tool Lists be sorted by provider?

Not at this time. The Lists can be sorted by who created them. 

Can Web Tool users in the same organization see each other’s claim information?

Users in the same organization based on the provider’s NPI number will be able to see claim information entered by other users.

Can you copy a Web Tool batch and then later delete an individual claim?

Yes, you can copy batches and delete selected claims.

Can you correct a Web Tool claim online?

Yes; this can be done by submitting a new claim. 

Can you export data from Web Tool?

Not at this time, however you can print screen and save it as a file.

Can you file Medicaid as secondary on Web Tool?

Yes, providers must file to all other payers and then input that information (received money) on the claim form on the Web Tool. There is a place to identify the hierarchy.

Can you print the batch ID?

Yes you can, by doing a file>print from the browser bar.

Can you resubmit a denied claim once correct on Web Tool?

Yes. Copy the claim, correct it, and submit it.

Can you resubmit the same claim via the Web Tool?

Yes, if you submit a new claim, you will get a new CCN.

Can you send me a copy of the Remittance Advice (RA)?

Copies of Remittance Advice statements can be retrieved online via the Web Tool.

If the remittance advice date is not available, complete a Duplicate Remittance Advice Request Form in the Forms Section of all provider manuals. There is a processing fee of $20 plus 20 cents per page copied. The charges will be deducted from a future Remittance Advice, appearing as a debit adjustment. The duplicate RA policy was enacted in December 2010.

Can you use the Web Tool for adjustments, if you filed through a clearinghouse?

Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim.

Do I have to request another Login and Password if more than one person wants to use the Web Tool?

Yes, all users must have their own individual login ID and Password to access the Web Tool.  If more than one user tries to login under the same login ID and Password, they will receive a denial message.

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.

Does Suspended mean processing?

No; Suspended means that the claim is in review. 

Does the Web Tool’s Lists feature allow you to save a beneficiary’s prior authorization in a field?

No, prior authorization may not be necessary for all services. There is a field for prior authorization.

Does Web Tool’s Status show whether it is approved to be paid?

Yes

How can I verify that my claims on the Web Tool have been submitted successfully?

If you received a batch number for the submission, then the submission reached MCCS. Go to Reports and click on the type of report that was sent (i.e.: CMS-1500, etc.). If a batch number is shown for the day and number of claims in the batch sent, the submission went through.

How can you find out MHN info for a beneficiary?

A provider can verify Medical Homes Network enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

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.

How soon does information show up in Web Tool’s Status?

After payments process

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 a beneficiary isn’t eligible, will the Web Tool show ineligible?

Yes, information is listed in red.

If I delete a person from the Web Tool list and the person returns, do I have to re-enter all of the information?

Yes. Once an entry is deleted, it is lost. You can choose to make the entry inactive, so you won’t see it.

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.

If I submit a claim through a vendor, will I be able to view it under Web Tool’s History?

No

If providers aren’t getting remits, who can they contact?

Provider Service Center/EDI

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 the Web Tool says they have 2 visits but the beneficiary goes somewhere else, how do we know if they have anymore visits?

Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services.

If you are checking a new person’s eligibility, can you add them to your recipient list from that screen?

Yes, there is a button to do that.

If you are missing information, will the Web Tool process the claim anyway?

Yes and no; there are basic required fields that are denoted by asterisks, however if you forget modifiers, the Web Tool won’t recognize that.

If you copy an entire Web Tool batch over, can you choose which claims to submit?

Yes

If you have primary diagnosis codes, do you have to add additional codes?

No, you just need the primary code.

If you make an error and you submit the claim on the Web Tool, is there a way to cancel or make a correction that same day?

Once a claim is submitted via the Web Tool, there is no way to cancel or make a correction to the submitted claim that same day.  Once the claim has gone through the payment cycle, you will be able to see if the claim has been rejected, paid, or suspended.  You will then be able to make corrections to the claim before resubmitting as a new claim.

In the Web Tool's status section, do claims purge based on batch ID?

They purge based on the check date.

Is the EFT form used for MCOs as well?

No, they have their own forms and billing systems.

Is the Web Tool claim ID number automatically entered?

Yes.

Is the Web Tool updated daily?

Yes, the Web Tool is updated every night.

Is there a limit to the number of claims in a Web Tool batch?

There is not a limit to the number of claims in a batch.

Is there a way to find a claim in History if you had not submitted it through the Web Tool?

No; you can only view that claim’s status.

Under the Web Tool's status option, can I check the status of a claim I submit hard copy?

Yes, it doesn’t matter the submission method.

What form needs to be completed for access to the Web Tool?

The trading partner agreement form needs to be completed.

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.

What is an MHN referral number?

If your service requires a referral, the MHN gives you an authorization number.

What is the payment cycle?

The payment cycle is: Wed-Mon, payments are processed on Tuesday, and payment is received as early as Friday.

What is the Web Tool’s Non-Contractual box?

The Non-Contractual box is to be selected/entered when the provider is not contracted with the beneficiary’s third party payer.

When a claim is in a denied status, can you do an adjustment?

You must wait for the rejection, and then do a correction. An adjustment can only be made to a paid claim.

When I try to change my Web Tool password, it keeps saying I haven’t met the criteria. What should I do?

The system recognizes when your password does not meet the password requirements.  However, if you have reviewed your selected password and it does meet the password requirements, contact the EDI Support Center at 1-888-289-0709, and choose Option “1”. 

When should eligibility be checked?

You should check before providing services.

When would you use a void?

You would use a void if you bill for something by mistake; accidental claim submission, for example.

Where are the carrier codes listed?

Appendix 2 of your SCDHHS Provider Manual.

Where can I attach documentation to my Web Tool claim?

On the Claim Entry screen, go to the Document tab to attach your documentation. (Effective August 17, 2015) Claims Attachments – Web Tool Reference Guide.

Why are Web Tool claims suspending?

Contact the PSC, option “2” for claims issues. 

Will MCO info be available via the Web Tool?

A provider can verify Managed Care Organization enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

Will systems recognize a duplicate claim if it is denied?

No, because it did not process. 

Will voids show up on the remit?

Yes

Will Web Tool list information auto-update for you as changes are made?

No, it is not tied to another system. Updates are your responsibility.

Would you ever get locked out of the Web Tool if you put your password in wrong?

No, there is no limit on password attempts.