If a Health Insurance Information Referral Form (HIIRF) is completed with no documentation, will the beneficiary's TPL record be updated?
If a plan doesn’t cover family planning, do we bill to Medicaid and send the EOB?
If I have a difficult payer, do I need to complete a reasonable effort document?
If I send a HIIRF, will I see anything saying it was received?
If my third party has several addresses, which one do I choose?
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?
What happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?
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.