Frequently Asked Questions


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Frequently Asked Questions

 

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THIRD PARTY LIABILITY (TPL)

Does the Medicaid card have all the information needed?

No, you should further investigate eligibility using eligibility resources and the information provided on the card.

For HIPP referral, who should you contact?

For HIPP referral, providers should contact the Medicaid Insurance Verification Services at 1-888-289-0709 option 5, option 4. The HIPP Fax is 803-462-2580.


How do patients learn updated information?

Patients learn of updates at their enrollment anniversary dates, or you may share information with them.


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

You have 30 days to request a hearing.

If a Health Insurance Information Referral Form (HIIRF) is completed with no documentation, will the beneficiary's TPL record be updated?

No, MIVS will further investigate and draft a letterhead showing steps taken.

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.

If I send a HIIRF, will I see anything saying it was received?

No, just wait a few days and check eligibility again.

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.

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. 



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