Learning Resources
Frequently Asked Questions
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How far back can you bill?Within 12 months | |
How do I know the charge?You can find the charge for the service in your provider manual. | |
Do you have to submit claims through Web Tool?No, you may use other options like hard copy or vendor/clearing house. | |
Do you have to put the last 4 digits of the zip code for Claims Entry?Yes; you can find zip codes on the US Postal Services website: www.usps.com. Click on Look Up a Zip Code™ | |
Do you have to put in diagnosis codes?If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. | |
Can you use the Web Tool for adjustments, if you filed through a clearinghouse?Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim. | |
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. | |
Can you resubmit a denied claim once correct on Web Tool?Yes. Copy the claim, correct it, and submit it. | |
When should eligibility be checked?You should check before providing services. | |
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. | |