Frequently Asked Questions


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Frequently Asked Questions

 

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WEB TOOL: CHECK ELIGIBILITY

Is the Web Tool updated daily?

Yes, the Web Tool is updated every night.


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.


What is an MHN referral number?

If your service requires a referral, the MHN gives you an authorization number.


When should eligibility be checked?

You should check before providing services.


Will MCO info be available via the Web Tool?

A provider can verify Managed Care Organization enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.


WEB TOOL: GETTING ACCESS

Can Web Tool users in the same organization see each other’s claim information?

Users in the same organization based on the provider’s NPI number will be able to see claim information entered by other users.


Do I have to request another Login and Password if more than one person wants to use the Web Tool?

Yes, all users must have their own individual login ID and Password to access the Web Tool.  If more than one user tries to login under the same login ID and Password, they will receive a denial message.


What form needs to be completed for access to the Web Tool?

The trading partner agreement form needs to be completed.


When I try to change my Web Tool password, it keeps saying I haven’t met the criteria. What should I do?

The system recognizes when your password does not meet the password requirements.  However, if you have reviewed your selected password and it does meet the password requirements, contact the EDI Support Center at 1-888-289-0709, and choose Option “1”. 


Would you ever get locked out of the Web Tool if you put your password in wrong?

No, there is no limit on password attempts. 



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