Frequently Asked Questions


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Frequently Asked Questions

 

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C

Can you resubmit the same claim via the Web Tool?

Yes, if you submit a new claim, you will get a new CCN.

Can you send me a copy of the Remittance Advice (RA)?

Copies of Remittance Advice statements can be retrieved online via the Web Tool.

If the remittance advice date is not available, complete a Duplicate Remittance Advice Request Form in the Forms Section of all provider manuals. There is a processing fee of $20 plus 20 cents per page copied. The charges will be deducted from a future Remittance Advice, appearing as a debit adjustment. The duplicate RA policy was enacted in December 2010.

Can you submit two claims forms to void/replace a ten-line claim?

Yes you can, as long as it is not a duplicate claim or void only; then, refile a 4-line and 6-line claim.

Can you use the Web Tool for adjustments, if you filed through a clearinghouse?

Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim.

D

Do all providers need to go through the provider revalidation process?

All South Carolina Healthy Connections Medicaid providers will go through the provider revalidation process. The current process, however, is for all South Carolina Healthy Connections Medicaid providers who have an enrollment date 90 days prior to or on 12/03/2012. These providers are required to go through the provider revalidation process. Revalidation FAQs PDF

Do all providers need to pay the provider revalidation application fee?

If you are an institutional provider as determined by CMS, you will need to pay a provider revalidation fee of $553.00 if you revalidate in 2015. The 2016 fee will be determined by CMS and will be published after it is established by CMS. If you are a provider with multiple NPIs associated with your Medicaid ID, you will need to complete a new enrollment for each non-primary NPI. You are responsible for the new enrollment fee/s. Revalidation FAQs PDF

Do I have to request another Login and Password if more than one person wants to use the Web Tool?

Yes, all users must have their own individual login ID and Password to access the Web Tool.  If more than one user tries to login under the same login ID and Password, they will receive a denial message.

Do I need to contact South Carolina Healthy Connections Medicaid to schedule a site visit?

No. If a site visit is needed, a Provider Relations Representative will contact you. Revalidation FAQs PDF

Do I need to pay a provider revalidation application fee?

If you are an institutional provider as determined by CMS, you will need to pay a provider revalidation fee of $553.00 if you revalidate in 2015. The 2016 fee will be determined by CMS and will be published after it is established by CMS. If you are a provider with multiple NPIs associated with your Medicaid ID, you will need to complete a new enrollment for each non-primary NPI. You are responsible for the new enrollment fees. Revalidation FAQs PDF

Do I still submit the UB-04 adjustment if I've submitted the credit balance report?

The MIVS credit balance reporting format is not eliminating or replacing a provider’s necessity to submit a UB-04 for claim adjustment(s).


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