Learning Resources
Frequently Asked Questions
| Third Party Liability (TPL) |
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. | |