Learning Resources
Frequently Asked Questions
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If the member doesn’t have an ID number for the MCO, how do we obtain it?Contact the MCO. | |
If I have two separate claims for one member, do I have to enter the claim information twice on Web Tool?Yes, you would have to submit two different claims. You can go to your submitted claim bucket and copy the claim with additional edits and changes and then resubmit it instead of rekeying two claims. | |
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 a member isn’t eligible, will the Web Tool show ineligible?Yes, information is listed in red. | |
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). | |
How can you find out MHN info for a member?A provider can verify Medical Homes Network enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section. | |
How are MCO plans chosen for a member if they are auto-enrolled?The plan is chosen based on the member’s needs, service area, and any needed specialists. | |
Does the Web Tool’s Lists feature allow you to save a member’s prior authorization in a field?No, prior authorization may not be necessary for all services. There is a field for prior authorization. | |
Does a member have to be on Medicaid to qualify for HIPP?No, but they must be Medicaid eligible. | |