Learning Resources
Frequently Asked Questions
| Web Tool |
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 the Web Tool’s Lists feature allow you to save a member’s prior authorization in a field?No, prior authorization may not be necessary for all services. There is a field for prior authorization. | |
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 member?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 | |