No, your lists are sharable.

No. Batches cannot be deleted at this time.

Yes. Key in the NPI or provider ID number and the recipient ID number and press submit.

Yes, by entering in information in the to and from fields.

No, however the edit code listing is found in Appendix 1 of your provider manual.

Not at this time. The Lists can be sorted by who created them. 

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

Yes, you can copy batches and delete selected claims.

Yes; this can be done by submitting a new claim. 

Yes, providers must file to all other payers and then input that information (received money) on the claim form on the Web Tool. There is a place to identify the hierarchy.

Yes. Copy the claim, correct it, and submit it.

Yes, if you submit a new claim, you will get a new CCN.

Copies of Remittance Advice statements can be retrieved online via the Web Tool.

If the remittance advice date is not available, complete a Duplicate Remittance Advice Request Form in the Forms Section of all provider manuals. There is a processing fee of $20 plus 20 cents per page copied. The charges will be deducted from a future Remittance Advice, appearing as a debit adjustment. The duplicate RA policy was enacted in December 2010.

Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim.

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.

If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. 

Yes; you can find zip codes on the US Postal Services website: www.usps.com.  Click on Look Up a Zip Code™

No, you may use other options like hard copy or vendor/clearing house.

No; Suspended means that the claim is in review. 

No, prior authorization may not be necessary for all services. There is a field for prior authorization.

Yes

If you received a batch number for the submission, then the submission reached MCCS. Go to Reports and click on the type of report that was sent (i.e.: CMS-1500, etc.). If a batch number is shown for the day and number of claims in the batch sent, the submission went through.

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

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).

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

Within 12 months

15 - 18 months

Three months.

After payments process

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.

Yes, information is listed in red.

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

Yes, you would have to submit two different claims. You can go to your submitted claim bucket and copy the claim with additional edits and changes and then resubmit it instead of rekeying two claims.

No

Provider Service Center/EDI

You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. 

Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services.

Yes, there is a button to do that.

Yes and no; there are basic required fields that are denoted by asterisks, however if you forget modifiers, the Web Tool won’t recognize that.

Yes

No, you just need the primary code.

Once a claim is submitted via the Web Tool, there is no way to cancel or make a correction to the submitted claim that same day.  Once the claim has gone through the payment cycle, you will be able to see if the claim has been rejected, paid, or suspended.  You will then be able to make corrections to the claim before resubmitting as a new claim.

They purge based on the check date.

No, they have their own forms and billing systems.

Yes.

Yes, the Web Tool is updated every night.

There is not a limit to the number of claims in a batch.

No; you can only view that claim’s status.

Yes, it doesn’t matter the submission method.

The trading partner agreement form needs to be completed.

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.

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

The payment cycle is: Wed-Mon, payments are processed on Tuesday, and payment is received as early as Friday.

The Non-Contractual box is to be selected/entered when the provider is not contracted with the beneficiary’s third party payer.

You must wait for the rejection, and then do a correction. An adjustment can only be made to a paid claim.

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”. 

You should check before providing services.

You would use a void if you bill for something by mistake; accidental claim submission, for example.

Appendix 2 of your SCDHHS Provider Manual.

On the Claim Entry screen, go to the Document tab to attach your documentation. (Effective August 17, 2015) Claims Attachments – Web Tool Reference Guide.

Contact the PSC, option “2” for claims issues. 

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

No, because it did not process. 

Yes

No, it is not tied to another system. Updates are your responsibility.

No, there is no limit on password attempts.