Sunday, July 14, 2024, 12:33 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

Can a billing provider be an ordering or referring provider as well?

Yes, as long as the provider is not designated as an ordering/referring provider exclusively. Future edits will prevent claims payment if an ordering/referring-only provider submits their NPI as a billing provider.

Can a customer service advocate tell me if another provider has started and saved a provider revalidation application?

No. The only information that the provider service center has is if a provider revalidation application has been completed and submitted. The provider service center cannot see if a provider has started the application process but not completed it. If you have the revalidation reference number, NPI and Medicaid ID of the provider in question, you can access the application to see if there is any work in progress. Revalidation FAQs PDF

Can a provider be moved from one risk category to another?

Yes, providers can be reassigned from the “limited” or “moderate” categories due to:

  • Imposition of a payment suspension within the previous 10 years
  • A provider or supplier has been terminated or is otherwise precluded from billing Medicaid
  • Exclusion by the OIG
  • A provider or supplier has been excluded from any federal health care program
  • A provider or supplier has had billing privileges revoked by a Medicaid contractor within the previous 10 years
  • A provider or supplier has been subjected to a final adverse action (as defined in 42 CFR 424.502) within the past 10 years
  • Instances in which CMS lifts a temporary moratorium for a particular provider or supplier type and a provider or supplier that was prevented from enrolling based on the moratorium, applies for enrollment as a Medicaid provider or supplier at any time within 6 months from the date the moratorium was lifted.

Can batches be deleted after they are sent?

No. Batches cannot be deleted at this time.

Can claims be lost via the Web Tool?

Generally, they don’t get lost using the web.

Can I add a beneficiary to the TAD if documentation is not approved?

You must have authorized signed documentation in order to add a beneficiary to your TAD. You should not add a beneficiary before the DHHS 181 is forwarded to DHHS Medicaid Eligibility for approval. Contact your Eligibility office if additional information is needed.

Can I check claim status on the Web Tool?

Yes. Key in the NPI or provider ID number and the recipient ID number and press submit.

Can I check on the status of my provider revalidation application?

Yes. You can check on the status of your provider revalidation application by calling the Provider Service Center at (888) 289-0709, option 4. You will need your revalidation reference number in order to check on the status of your provider revalidation application. Revalidation FAQs PDF

Can I do a span date on the Web Tool?

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

Can I handwrite on the claim forms?

Yes you can, or you use a printing service.

Can I request an extension?

Extensions will not be granted due to the stringent timelines mandated by Federal Regulation 455.104 (b), (c), and 455450 (e). Revalidation FAQs PDF

Can I save my provider revalidation application and return to it later?

Yes. There are certain points that are clearly defined in the provider revalidation application process where you can save your work and exit the application. An incomplete application will be deleted and unable to be recovered 30 days from the day the application was created. Revalidation FAQs PDF

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.

Can the HIIRF form be faxed?

The HIIRF can be faxed to Medicaid Insurance Verification Services at (803) 252-0870.

Can we find edit codes on the Web Tool?

No, however the edit code listing is found in Appendix 1 of your provider manual.

Can Web Tool Lists be sorted by provider?

Not at this time. The Lists can be sorted by who created them. 

Can Web Tool users in the same organization see each other’s claim information?

Users in the same organization based on the provider’s NPI number will be able to see claim information entered by other users.

Can you accept a beneficiary as just a private pay patient even if they have Medicaid?

Yes, you just have to let them know before they receive any services.

Can you add beneficiaries or other information to the TAD for me?

No, MCCS staff cannot add any information to the TAD. You can only make changes via DHHS Form 181, CRCF 01 and IPC change forms.

Can you assist with Medicaid/bed hold billing procedures?

An authorized SNF 181 along with a separate Medicare-to-Medicaid bed hold billing 181 is required.

Can you copy a Web Tool batch and then later delete an individual claim?

Yes, you can copy batches and delete selected claims.

Can you correct a Web Tool claim online?

Yes; this can be done by submitting a new claim. 

Can you correct the 181/CRCF-01 form?

No. MCCS staff cannot make corrections to the DHHS Form 181 or CRCF 01 form.

Can you export data from Web Tool?

Not at this time, however you can print screen and save it as a file.

Can you file Medicaid as secondary on Web Tool?

Yes, providers must file to all other payers and then input that information (received money) on the claim form on the Web Tool. There is a place to identify the hierarchy.

Can you only see a certain amount of beneficiaries?

Yes, but you must have a visible sign stating so.

Can you print the batch ID?

Yes you can, by doing a file>print from the browser bar.

Can you resubmit a denied claim once correct on Web Tool?

Yes. Copy the claim, correct it, and submit it.

Can you resubmit the same claim via the Web Tool?

Yes, if you submit a new claim, you will get a new CCN.

Can you send me a copy of the Remittance Advice (RA)?

Copies of Remittance Advice statements can be retrieved online via the Web Tool.

If the remittance advice date is not available, complete a Duplicate Remittance Advice Request Form in the Forms Section of all provider manuals. There is a processing fee of $20 plus 20 cents per page copied. The charges will be deducted from a future Remittance Advice, appearing as a debit adjustment. The duplicate RA policy was enacted in December 2010.

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.

Can you use the Web Tool for adjustments, if you filed through a clearinghouse?

Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim.