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Repairs
Provider Overview
HealthRules
EX Codes
Claim Forms
100
The Mommy's Medicaid Id with "01" at the end.
What is a newborn proxy number?
100
Often in Location 11 or 72, this clinic has 150 beds or less.
What is an RHC?
100
How you can edit a claim.
What is Open for Edit?
100
02
What is the EX Code used to tell the provider that a modifier is required?
100
A corporate social security number?
A Tax ID?
200
Clicking Validate.
How you check to see if the "Red" went away?
200
The doctor who performs services on the patient.
What is a Practitioner?
200
How I can see additional information for the member.
What does clicking on the member's hyperlinked name do?
200
TH
What is the EX Code used when the TIN and NPI don't match?
200
UB04
What claim form is an Institutional Claim Billed on?
300
Reject the claim
What is a claim that's too messed up to deny?
300
Under the Practitioner Name; This field in required and you should always make sure it populates.
What is a Role?
300
A routing method used to get problems with a claim fixed by another department.
What is an Issue?
300
8N
What is the EX Code used when the provider doesn't submit a TIN?
300
Where you can find the Supplier Id.
What's in box 33A of a CMS 1500 or HCFA?
400
Enrollment Medicaid
Where issues go for newborns?
400
RHC / FQHC / Labs / Some Rehabs
What Suppliers Do Not Require a Rendering Practitioner?
400
Clicking on the Benefit Adjudication tab.
How can you tell if a claim is In or Out of network?
400
EX DU
What is the EX Code Used to identify a Duplicate Claim?
400
Identifies which diagnosis each line references.
What are the diagnosis pointers?
500
How you see the history of a claim.
What is the Audit Log?
500
Every provider must have one to bill in Texas Medicaid
What is a TPI?
500
A Claim in the Workbasket that must be viewed by a live person.
What is a Review?
500
EX 65
What is the EX Code Used to tell that the service is not a benefit of TX Medicaid?
500
How we identify if a claim's been re-entered into HealthRules?
What is the RE at the end of a claim number?