Learning Resources
Frequently Asked Questions
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Do other states have provider revalidation?Yes, all 50 states have been mandated to perform provider revalidation. Revalidation FAQs PDF | |
Do we need to send an EOB?An Explanation of Benefits from a third party payer should be kept on file in the provider’s office, especially if the payer didn’t submit payment. | |
Do we send an EOB with claims?You do not send an EOB with claims, unless it is requested. | |
Do you file to another payer when you know services are not covered?Yes, this is considered a valid denial. | |
Do you have to ask MIVS to research TPL non-payment?No, they do this on their own to ensure payment. | |
Do you have to put in diagnosis codes?If the service you are providing requires the use of a diagnosis code, then you must enter the diagnosis code with your claim information. | |
Do you have to put the last 4 digits of the zip code for Claims Entry?Yes; you can find zip codes on the US Postal Services website: www.usps.com. Click on Look Up a Zip Code™ | |
Do you have to submit claims through Web Tool?No, you may use other options like hard copy or vendor/clearing house. | |
Does a beneficiary have to be on Medicaid to qualify for HIPP?No, but they must be Medicaid eligible. | |
Does Suspended mean processing?No; Suspended means that the claim is in review. | |