Learning Resources
Frequently Asked Questions
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If providers aren’t getting remits, who can they contact?Provider Service Center/EDI | |
If the member doesn’t have an ID number for the MCO, how do we obtain it?Contact the MCO. | |
If the Web Tool says they have 2 visits but the member 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 member list from that screen? Yes, there is a button to do that.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. | |