Frequently Asked Questions


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Frequently Asked Questions

 

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A

Are program representatives organized by demographics?

Yes they are, depending on service area.

Are Web Tool lists separated by login?

No, your lists are sharable.

C

Can a billing provider be an ordering or referring provider as well?

Yes, as long as the provider is not designated as an ordering/referring provider exclusively. Future edits will prevent claims payment if an ordering/referring-only provider submits their NPI as a billing provider.

Can a customer service advocate tell me if another provider has started and saved a provider revalidation application?

No. The only information that the provider service center has is if a provider revalidation application has been completed and submitted. The provider service center cannot see if a provider has started the application process but not completed it. If you have the revalidation reference number, NPI and Medicaid ID of the provider in question, you can access the application to see if there is any work in progress. Revalidation FAQs PDF

Can a provider be moved from one risk category to another?

Yes, providers can be reassigned from the “limited” or “moderate” categories due to:

  • Imposition of a payment suspension within the previous 10 years
  • A provider or supplier has been terminated or is otherwise precluded from billing Medicaid
  • Exclusion by the OIG
  • A provider or supplier has been excluded from any federal health care program
  • A provider or supplier has had billing privileges revoked by a Medicaid contractor within the previous 10 years
  • A provider or supplier has been subjected to a final adverse action (as defined in 42 CFR 424.502) within the past 10 years
  • Instances in which CMS lifts a temporary moratorium for a particular provider or supplier type and a provider or supplier that was prevented from enrolling based on the moratorium, applies for enrollment as a Medicaid provider or supplier at any time within 6 months from the date the moratorium was lifted.

Can batches be deleted after they are sent?

No. Batches cannot be deleted at this time.

Can claims be lost via the Web Tool?

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

Can I add a beneficiary to the TAD if documentation is not approved?

You must have authorized signed documentation in order to add a beneficiary to your TAD. You should not add a beneficiary before the DHHS 181 is forwarded to DHHS Medicaid Eligibility for approval. Contact your Eligibility office if additional information is needed.

Can I check claim status on the Web Tool?

Yes. Key in the NPI or provider ID number and the recipient ID number and press submit.

Can I check on the status of my provider revalidation application?

Yes. You can check on the status of your provider revalidation application by calling the Provider Service Center at (888) 289-0709, option 4. You will need your revalidation reference number in order to check on the status of your provider revalidation application. Revalidation FAQs PDF


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