Monday, June 30, 2025, 5:07 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
If I have a difficult payer, do I need to complete a reasonable effort document?Yes you can. It is to show efforts made to obtain other payments from other insurers. |
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. |
Where are the specifics for pay and chase?The specifics for pay and chase are found in Section 2 (polices) and section 3 (billing) of your provider manual. |
Can you resubmit a denied claim once correct on Web Tool?Yes. Copy the claim, correct it, and submit it. |
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. |
Is the EFT form used for MCOs as well?No, they have their own forms and billing systems. |
If you are missing information, will the Web Tool process the claim anyway?Yes and no; there are basic required fields that are denoted by asterisks, however if you forget modifiers, the Web Tool won’t recognize that. |
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. |
Can I do a span date on the Web Tool?Yes, by entering in information in the to and from fields. |
How do I know the charge?You can find the charge for the service in your provider manual. |