Learning Resources
Frequently Asked Questions
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If doing a void/replace adjustment, does the Form 130 go along with the CMS-1500 claim form?Yes, the replacement claim will be attached to the Form 130. | |
How are split claims broken up?A 10 in your CCN represents 8 lines; 20 is the next 8 lines, etc. | |
How long does it take to process an adjustment?It takes approximately 30-45 days to process an adjustment - the same as a normal claim in process. | |
Where can carrier codes be located?Carrier Codes can be located in Appendix 2 of the Provider Manual. | |
What do you do if you contact a Primary Care Provider and they have no record of a patient?If this were to happen, you would need to contact the Managed Care Organization directly. | |
How can you get copies of enrollment letters?To receive a copy of a beneficiary’s enrollment letter, they may contact Healthy Connections Choices or the beneficiary’s plan (that they were enrolled into). | |
How are MCO plans chosen for a beneficiary if they are auto-enrolled?The plan is chosen based on the beneficiary’s needs, service area, and any needed specialists. | |
Do we need to send an EOB?An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment. | |
How does Medicaid know what the provider is receiving from another carrier/third party payer?There are spaces/sections on the claim form that identify what you receive from the other carrier. | |
Can I handwrite on the claim forms?Yes you can, or you use a printing service. | |