Learning Resources
Frequently Asked Questions
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Do I still submit the UB-04 adjustment if I've submitted the credit balance report? | |
What is a credit balance?A credit balance is a positive amount that remains in a patient’s account which may have resulted from multiple reimbursements from several payers, adjustments to previously paid claims of a provider, duplicate payment, or subrogation events due to accidents and other injury cases. When another third party payer reimburses a provider for claims that Medicaid paid, either in part or in full, a refund is due to the Medicaid Program. | |
Can the HIIRF form be faxed?The HIIRF can be faxed to Medicaid Insurance Verification Services at (803) 252-0870. | |
If the beneficiary 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. | |
Can we find edit codes on the Web Tool?No, however the edit code listing is found in Appendix 1 of your provider manual. | |
Can I do a span date on the Web Tool?Yes, by entering in information in the to and from fields. | |
Is the EFT form used for MCOs as well?No, they have their own forms and billing systems. | |
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. | |
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. | |