Monday, June 30, 2025, 5:10 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
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. |
What do you do if you contact a Primary Care Provider and they have no record of a patient?If this were to happen, you would need to contact the Managed Care Organization directly. |
Where can carrier codes be located?Carrier Codes can be located in Appendix 2 of the Provider Manual. |
How long does it take to process an adjustment?It takes approximately 30-45 days to process an adjustment - the same as a normal claim in process. |
How are split claims broken up?A 10 in your CCN represents 8 lines; 20 is the next 8 lines, etc. |
If doing a void/replace adjustment, does the Form 130 go along with the CMS-1500 claim form?Yes, the replacement claim will be attached to the Form 130. |
Can claims be lost via the Web Tool?Generally, they don’t get lost using the web. |
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. |