Learning Resources
Frequently Asked Questions
| Third Party Liability (TPL) |
Can MIVS track down where other payer’s money goes if you are not paid?No, but they can contact other payers to obtain payment information. | |
Can the HIIRF form be faxed?The HIIRF can be faxed to Medicaid Insurance Verification Services at (803) 252-0870. | |
Can you accept a beneficiary as just a private pay patient even if they have Medicaid?Yes, you just have to let them know before they receive any services. | |
Do we need to send an EOB?An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment. | |
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. | |
Do you have to ask MIVS to research TPL non-payment?No, they do this on their own to ensure payment. | |
Does the Medicaid card have all the information needed?No, you should further investigate eligibility using eligibility resources and the information provided on the card. | |
For HIPP referral, who should you contact?For HIPP referral, providers should contact the Medicaid Insurance Verification Services at 1-888-289-0709 option 5, option 4. The HIPP Fax is 803-462-2580. | |
How do patients learn updated information?Patients learn of updates at their enrollment anniversary dates, or you may share information with them. | |
How long do you have to request a hearing for an appeal?You have 30 days to request a hearing. | |
If a Health Insurance Information Referral Form (HIIRF) is completed with no documentation, will the beneficiary's TPL record be updated?No, MIVS will further investigate and draft a letterhead showing steps taken. | |
If a plan doesn’t cover family planning, do we bill to Medicaid and send the EOB? | |
If I have a difficult payer, do I need to complete a reasonable effort document?Yes you can. It is to show efforts made to obtain other payments from other insurers. | |
If I send a HIIRF, will I see anything saying it was received?No, just wait a few days and check eligibility again. | |
If my third party has several addresses, which one do I choose?You would contact the company to find out which address is for your service area. | |
If you know a service isn’t covered, do you still file to the other carrier?Yes, you still file to the other carrier to obtain a valid denial. Three denials should be kept on file each year. | |
What do you do if monies are sent to the patient?Change them to self pay after or before service completion. | |
What happens when Medicaid recoups for retro-health recovery and it is outside of the timely filing window?Professional billers do not receive retro health letters. Medicaid contacts or solicits billing payments from the private health plan. | |
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. | |
Where are the specifics for pay and chase?The specifics for pay and chase are found in Section 2 (polices) and section 3 (billing) of your provider manual. | |