Thursday, October 29, 2020, 6:30 AM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

Can MIVS track down where other payer’s money goes if you are not paid?

No, but they can contact other payers to obtain payment information.

How long do you have to request a hearing for an appeal?

You have 30 days to request a hearing.

If my third party has several addresses, which one do I choose?

You would contact the company to find out which address is for your service area.

What happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?

Professional billers do not receive retro health letters. Medicaid contacts or solicits billing payments from the private health plan.

If a plan doesn’t cover family planning, do we bill to Medicaid and send the EOB?

Certain services are “carved out”, not covered, by the MCOs and MHNs. Those services can be billed directly to SC Medicaid. You do not need to bill to the managed care plan for a denial.

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.

Is the EFT form used for MCOs as well?

No, they have their own forms and billing systems.

Can I do a span date on the Web Tool?

Yes, by entering in information in the to and from fields.