Frequently Asked Questions


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Frequently Asked Questions

 

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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).

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.

Where can carrier codes be located?

Carrier Codes can be located in Appendix 2 of the Provider Manual.

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.

How are split claims broken up?

A 10 in your CCN represents 8 lines; 20 is the next 8 lines, etc.

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.

Can claims be lost via the Web Tool?

Generally, they don’t get lost using the web.

If you have a multiline claim and only one line needs recouping, you still complete an adjustment?

Yes, claims are 100% adjusted, all lines will be replaced.

What happens if someone in your office initiates a refund with the 205 and an adjustment, how do you get it back?

The program area would have to research the adjustment to return funds.

What happens if you void the wrong claim?

If it is voided, you can submit a new claim in.

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