Tuesday, July 16, 2024, 5:10 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

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