Frequently Asked Questions


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Frequently Asked Questions

 

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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.

Do we send an EOB with claims?

You do not send an EOB with claims, unless it is requested.

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.

Can you resubmit a denied claim once correct on Web Tool?

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


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.


Is the EFT form used for MCOs as well?

No, they have their own forms and billing systems.


If you are missing information, will the Web Tool process the claim anyway?

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.


Under the Web Tool's status option, can I check the status of a claim I submit hard copy?

Yes, it doesn’t matter the submission method.


Can I do a span date on the Web Tool?

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


How do I know the charge?

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



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