Learning Resources
Frequently Asked Questions
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If a plan doesn’t cover family planning, do we bill to Medicaid and send the EOB? | |
If I have a difficult payer, do I need to complete a reasonable effort document?Yes you can. It is to show efforts made to obtain other payments from other insurers. | |
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. | |
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. | |
Can you resubmit a denied claim once correct on Web Tool?Yes. Copy the claim, correct it, and submit it. | |
If you know a service isn’t covered, do you still file to the other carrier?Yes, you still file to the other carrier to obtain a valid denial. Three denials should be kept on file each year. | |
Is the EFT form used for MCOs as well?No, they have their own forms and billing systems. | |
If you are missing information, will the Web Tool process the claim anyway?Yes and no; there are basic required fields that are denoted by asterisks, however if you forget modifiers, the Web Tool won’t recognize that. | |
Under the Web Tool's status option, can I check the status of a claim I submit hard copy?Yes, it doesn’t matter the submission method. | |