Frequently Asked Questions


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Frequently Asked Questions

 

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If providers aren’t getting remits, who can they contact?

Provider Service Center/EDI


If the beneficiary doesn’t have an ID number for the MCO, how do we obtain it?

Contact the MCO.

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. 


If the Web Tool says they have 2 visits but the beneficiary goes somewhere else, how do we know if they have anymore visits?

Web Tool is updated nightly; you should always check and if they are out of visits, let them know before providing services.


If you are checking a new person’s eligibility, can you add them to your recipient list from that screen?

Yes, there is a button to do that.


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.


If you copy an entire Web Tool batch over, can you choose which claims to submit?

Yes


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.

If you have primary diagnosis codes, do you have to add additional codes?

No, you just need the primary code.


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.



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