Learning Resources
Frequently Asked Questions
| All categories |
THIRD PARTY LIABILITY (TPL) |
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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. | |
What do you do if monies are sent to the patient?Change them to self pay after or before service completion. | |
What if a claim is created, but the member says that he/she no longer has the insurance on file?If a member no longer has the insurance policy that is seen on the Web Tool, the provider can refer the member to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the member’s third party payer information. Making a change to a policy that already exists in the Medicaid Management Information System (MMIS) takes five days. The HIIRF Form can be faxed to 803-252-0870. | |
Where are the specifics for pay and chase?The specifics for pay and chase are found in Section 2 (polices) and section 3 (billing) of your provider manual. | |
WEB TOOL |
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Are Web Tool lists separated by login?No, your lists are sharable. | |
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 check claim status on the Web Tool?Yes. Key in the NPI or provider ID number and the member ID number and press submit. | |
Can I do a span date on the Web Tool?Yes, by entering in information in the to and from fields. | |