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System Benefits

New system benefits for providers

  • Manage your account/passwords.
  • Online claim entry through the web portal.
  • Ability to upload X12 batch transactions.
  • Immediate response that summarizes key payment information including amount to be paid, recipient liability, co-pay information, and deductibles when submitting through the web portal.
  • Inquire on the status of claims processed and payment history.
  • Inquire on claims in suspense.
  • Correct Coding Initiative (CCI) edits and services within the global periods will be applied using automated technology. This will result in a consistent application of standards and guidelines and may affect the adjudication of the claim.
  • Easy access to the billing manuals, coding guidelines, companion guides, co-pays and limits.
  • Online message board for Medicaid announcements and messages.
  • Online mailbox for items such as provider bulletin, correspondence and electronic transactions.
  • Report fraud or abuse online anonymously.

New system benefits for members

  • General eligibility rules.
  • Find a healthcare provider that is enrolled in Medicaid. This will allow the member to search for a provider based on their name, specialty, location, or other criteria. It is meant to assist the member in locating a provider that will meet the needs whether it is specific to a specialty or to find the closest provider to the members home.
  • Display doctors/providers visited. This will allow the member to search for doctors and/or providers that the member has visited in the past. The member is able to search by the date of the visit and/or by the name of the provider.
  • Primary Care Physician lookup.
  • Display claims processed. This will allow the member to search for claims that have been submitted on behalf of the member. The member is able to search for a claim by the date the service was rendered and/or the provider rendering the service.
  • Inquire on the status of program limits.
  • Inquire on the status of Service Authorizations.
  • Report fraud or abuse online anonymously.

 

 

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