Saturday, March 22, 2025, 2:05 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
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If providers aren’t getting remits, who can they contact?Provider Service Center/EDI |
If the member doesn’t have an ID number for the MCO, how do we obtain it?Contact the MCO. |
If the member had Champus or Tri-Care and it paid 100%, why would I need to file to Medicaid?You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. |
If the Web Tool says they have 2 visits but the member goes somewhere else, how do we know if they have anymore visits?Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services. |
If you are checking a new person’s eligibility, can you add them to your member list from that screen? Yes, there is a button to do that.Yes, there is a button to do that. |
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. |
If you copy an entire Web Tool batch over, can you choose which claims to submit?Yes |
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. |
If you have primary diagnosis codes, do you have to add additional codes?No, you just need the primary code. |
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. |