Frequently Asked Questions

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Frequently Asked Questions

 

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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.

Can I check claim status on the Web Tool?

Yes. Key in the NPI or provider ID number and the member ID number and press submit.

Why would a Nursing Facility provider receive a 951 rejection if the member had always been eligible for NF Medicaid since entering the facility?

A 951 Edit Code means the member was not eligible for Medicaid on the date of service. The member and/or responsible party for the member might not have completed the annual Medicaid eligibility review. Inform the nursing facility caller to contact the member’s eligibility caseworker.                                                                                                                                                                                

What is the Web Tool’s Non-Contractual box?

The Non-Contractual box is to be selected/entered when the provider is not contracted with the member’s third party payer.

What if you know any other office has a claim waiting to be filed that uses the same visit counts you will be using to file a claim for a member?

You should also file right away. Area representatives can approve a few extra visits, but not every time.

What if a claim is created, but the member says that he/she no longer has the insurance on file?

If a member no longer has the insurance policy that is seen on the Web Tool, the provider can refer the member to their eligibility counselor/worker, or complete the Health Insurance Information Referral Form (HIIRF) to update the member’s third party payer information. Making a change to a policy that already exists in the Medicaid Management Information System (MMIS) takes five days. The HIIRF Form can be faxed to 803-252-0870.

What do you do if a member is out of visit counts?

When checking eligibility, you will see what visit counts they have left. You can request more from your representative or treat them as a self pay.

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

Contact the MCO.

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