Tuesday, July 16, 2024, 4:47 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

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.