Frequently Asked Questions


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Frequently Asked Questions

 

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THIRD PARTY LIABILITY (TPL)

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 happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?

Professional billers do not receive retro health letters. Medicaid contacts or solicits billing payments from the private health plan.

What if a claim is created, but the beneficiary says that he/she no longer has the insurance on file?

If a beneficiary no longer has the insurance policy that is seen on the Web Tool, the provider can refer the beneficiary to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the beneficiary’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

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 recipient 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.



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