Monday, May 6, 2024, 4:28 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
If you have a multiline claim and only one line needs recouping, you still complete an adjustment?Yes, claims are 100% adjusted, all lines will be replaced. |
What happens if someone in your office initiates a refund with the 205 and an adjustment, how do you get it back?The program area would have to research the adjustment to return funds. |
What happens if you void the wrong claim?If it is voided, you can submit a new claim in. |
Can you submit two claims forms to void/replace a ten-line claim?Yes you can, as long as it is not a duplicate claim or void only; then, refile a 4-line and 6-line claim. |
Is an adjustment only done when you have been paid?Yes, only paid claims can receive an overpayment or underpayment. |
Will the system distinguish that a company has multiple provider numbers?Yes, make sure all their information is correct when completing the claim form. |
Do you file to another payer when you know services are not covered?Yes, this is considered a valid denial. |
What if you know any other office has a claim waiting to be filed that uses the same visit counts you will be using to file a claim for a beneficiary?You should also file right away. Area representatives can approve a few extra visits, but not every time. |
Do you have to ask MIVS to research TPL non-payment?No, they do this on their own to ensure payment. |
For HIPP referral, who should you contact?For HIPP referral, providers should contact the Medicaid Insurance Verification Services at 1-888-289-0709 option 5, option 4. The HIPP Fax is 803-462-2580. |