Learning Resources
Frequently Asked Questions
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WEB TOOL |
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Do you have to put in diagnosis codes?If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. | |
Do you have to put the last 4 digits of the zip code for Claims Entry?Yes; you can find zip codes on the US Postal Services website: www.usps.com. Click on Look Up a Zip Code™ | |
Do you have to submit claims through Web Tool?No, you may use other options like hard copy or vendor/clearing house. | |
Does Suspended mean processing?No; Suspended means that the claim is in review. | |
Does Web Tool’s Status show whether it is approved to be paid?Yes | |
How can I verify that my claims on the Web Tool have been submitted successfully? | |
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. | |