Frequently Asked Questions

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Frequently Asked Questions


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Will a provider be notified if they are terminated “for cause” and do they have appeal rights?

Yes, a provider will be notified via certified mail when terminated for cause. The provider does have appeal rights.

Will every Nursing Facility or Intermediate Care Facility (ICF) / Mental Retardation (MR) have the same rate?


Will I need a site visit?

All moderate and high risk providers will need a site visit. The site visit must occur within 30 days from the date on the revalidation notification letter. Revalidation FAQs PDF

Will MCO info be available via the Web Tool?

A provider can verify Managed Care Organization enrollment on the eligibility section of the Web Tool under the “Beneficiary Special Program Data” section.

Will my claims from two weeks ago process if I just enrolled today?

Upon approval of enrollment (the provider has met all necessary requirements); the enrollment date of the provider’s effective date will retroactively begin 90 days prior to the date of receipt of the application. However, depending on the provider’s type/ specialty, if the provider is required to sign a contractual agreement in addition to the provider enrollment agreement, the enrollment date is the effective date of the contract. Note: Medicaid will not pay for claims prior to an enrollment effective date or before the provider’s licensure/certification date.

Will recertification dates be listed on Web Tool?

No, it would violate HIPPA.

Will systems recognize a duplicate claim if it is denied?

No, because it did not process. 

Will the entities in each screening category stay the same?

CMS will continuously evaluate whether they need to change the assignment of categories of providers and suppliers to various risk categories.  If they assign certain groups of providers and/or suppliers to a different category, this change will be proposed in the Federal Register.

Will the hospice agency receive a copy of the DHHS Form 181 when the recurring income changes?

Yes, they will receive a copy of the 181 to verify the income change. It is recommended that the NF or ICF/MR attach a copy of the most current 181 when invoicing the hospice. Recurring income is noted in Section III of DHHS Form 181. Medicaid Eligibility is responsible for determining recurring income.

Will the system distinguish that a company has multiple provider numbers?

Yes, make sure all their information is correct when completing the claim form.

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