Sunday, April 28, 2024, 5:16 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
Will recertification dates be listed on Web Tool?No, it would violate HIPPA. |
If the beneficiary doesn’t have an ID number for the MCO, how do we obtain it?Contact the MCO. |
Can you resubmit the same claim via the Web Tool?Yes, if you submit a new claim, you will get a new CCN. |
What should I do if one line does not pay on your claim?Correct and refile that one line. |
Can I handwrite on the claim forms?Yes you can, or you use a printing service. |
How does Medicaid know what the provider is receiving from another carrier/third party payer?There are spaces/sections on the claim form that identify what you receive from the other carrier. |
Do we need to send an EOB?An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment. |
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. |
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 are MCO plans chosen for a beneficiary if they are auto-enrolled?The plan is chosen based on the beneficiary’s needs, service area, and any needed specialists. |