Frequently Asked Questions


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Frequently Asked Questions

 

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WEB TOOL

If the beneficiary 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. 

Entry link: If the beneficiary had Champus or Tri-Care and it paid 100%, why would I need to file to Medicaid?

If the Web Tool says they have 2 visits but the beneficiary 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.

Entry link: If the Web Tool says they have 2 visits but the beneficiary goes somewhere else, how do we know if they have anymore visits?

If you are checking a new person’s eligibility, can you add them to your recipient list from that screen?

Yes, there is a button to do that.

Entry link: If you are checking a new person’s eligibility, can you add them to your recipient list from that screen?

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.

Entry link: If you are missing information, will the Web Tool process the claim anyway?

If you copy an entire Web Tool batch over, can you choose which claims to submit?

Yes

Entry link: If you copy an entire Web Tool batch over, can you choose which claims to submit?

If you have primary diagnosis codes, do you have to add additional codes?

No, you just need the primary code.

Entry link: If you have primary diagnosis codes, do you have to add additional codes?

If you make an error and you submit the claim on the Web Tool, is there a way to cancel or make a correction that same day?

Once a claim is submitted via the Web Tool, there is no way to cancel or make a correction to the submitted claim that same day.  Once the claim has gone through the payment cycle, you will be able to see if the claim has been rejected, paid, or suspended.  You will then be able to make corrections to the claim before resubmitting as a new claim.

Entry link: If you make an error and you submit the claim on the Web Tool, is there a way to cancel or make a correction that same day?

In the Web Tool's status section, do claims purge based on batch ID?

They purge based on the check date.

Entry link: In the Web Tool's status section, do claims purge based on batch ID?

Is the EFT form used for MCOs as well?

No, they have their own forms and billing systems.

Entry link: Is the EFT form used for MCOs as well?

Is the Web Tool claim ID number automatically entered?

Yes.

Entry link: Is the Web Tool claim ID number automatically entered?


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