Frequently Asked Questions


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Frequently Asked Questions

 

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SCREENING REQUIREMENTS

Will the entities in each screening category stay the same?

CMS will continuously evaluate whether they need to change the assignment of categories of providers and suppliers to various risk categories.  If they assign certain groups of providers and/or suppliers to a different category, this change will be proposed in the Federal Register.


THIRD PARTY LIABILITY (TPL)

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 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.

Do we need to send an EOB?

An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment.

Do we send an EOB with claims?

You do not send an EOB with claims, unless it is requested.

Do you have to ask MIVS to research TPL non-payment?

No, they do this on their own to ensure payment.

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.



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