Learning Resources
Frequently Asked Questions
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How can you get copies of enrollment letters?To receive a copy of a member’s enrollment letter, they may contact Healthy Connections Choices or the member’s plan (that they were enrolled into). | |
If a member isn’t eligible, will the Web Tool show ineligible?Yes, information is listed in red. | |
If a Health Insurance Information Referral Form (HIIRF) is completed with no documentation, will the member's TPL record be updated?No, MIVS will further investigate and draft a letterhead showing steps taken. | |
If the member doesn’t have an ID number for the MCO, how do we obtain it?Contact the MCO. | |
If the member had Champus or Tri-Care and it paid 100%, why would I need to file to Medicaid?You would need to file to Medicaid for reporting purposes and for seeing the claim through from beginning to end. | |
If the Web Tool says they have 2 visits but the member 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. | |
What do you do if a member is out of visit counts?When checking eligibility, you will see what visit counts they have left. You can request more from your representative or treat them as a self pay. | |
What if a claim is created, but the member says that he/she no longer has the insurance on file?If a member no longer has the insurance policy that is seen on the Web Tool, the provider can refer the member to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the member’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. | |
What if you know any other office has a claim waiting to be filed that uses the same visit counts you will be using to file a claim for a member?You should also file right away. Area representatives can approve a few extra visits, but not every time. | |