Frequently Asked Questions

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Frequently Asked Questions


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How can you find out MHN info for a beneficiary?

A provider can verify Medical Homes Network enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

How do I file a replacement claim for a paid claim that is partly incorrect?

Go to the Web Tool submission page. Log in; go to claims entry/history; click on the correct batch number; click on the correct claim number; copy; click the claim type on the left; click on batch, claim; edit; scroll down to claim submission reason code; select replacement. To complete this task, you must have the original Claim Control Number (CCN).

How do I know the charge?

You can find the charge for the service in your provider manual.

How far back can you bill?

Within 12 months

How far back can you file a void?

15 - 18 months

How long will a Web Tool claim stay out as a draft?

Three months.

How soon does information show up in Web Tool’s Status?

After payments process

I cannot enter all of the characters in a procedure code or a diagnosis code. Can you help me?

Remove decimal points from the code. To start afresh, backspace to the beginning of the field or highlight the characters in the code and press delete.

If a beneficiary isn’t eligible, will the Web Tool show ineligible?

Yes, information is listed in red.

If I delete a person from the Web Tool list and the person returns, do I have to re-enter all of the information?

Yes. Once an entry is deleted, it is lost. You can choose to make the entry inactive, so you won’t see it.

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