Learning Resources
Frequently Asked Questions
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How can you get copies of enrollment letters?To receive a copy of a beneficiary’s enrollment letter, they may contact Healthy Connections Choices or the beneficiary’s plan (that they were enrolled into). | |
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. | |
What do you do if you contact a Primary Care Provider and they have no record of a patient?If this were to happen, you would need to contact the Managed Care Organization directly. | |
Can you file Medicaid as secondary on Web Tool?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. | |
Where can carrier codes be located?Carrier Codes can be located in Appendix 2 of the Provider Manual. | |
How long does it take to process an adjustment?It takes approximately 30-45 days to process an adjustment - the same as a normal claim in process. | |
How are split claims broken up?A 10 in your CCN represents 8 lines; 20 is the next 8 lines, etc. | |
If doing a void/replace adjustment, does the Form 130 go along with the CMS-1500 claim form?Yes, the replacement claim will be attached to the Form 130. | |
Can claims be lost via the Web Tool?Generally, they don’t get lost using the web. | |
If the Web Tool says they have 2 visits but the beneficiary goes somewhere else, how do we know if they have anymore visits?Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services. | |