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Frequently Asked Questions
Provider FAQ's  

1.  Can an out of state provider be reimbursed for services rendered to a MS beneficiary?
     Pursuant to 42 CFR § 431.52, the Mississippi Division of Medicaid is only required to pay for services furnished in another state if certain conditions are met. Please refer to the Mississippi Medicaid State Plan and Miss. Admin Code Title 23 for coverage and reimbursement requirements.

2.  Does the Division of Medicaid enroll Out of State providers?
     The Division of Medicaid may enroll an out of state provider to cover medical services for the following reasons: An emergency medical condition as defined in Miss. Admin. Code Title 23, Part 201, Rule 1.2.G; the beneficiary¿s health would be endangered if they were required to travel to their state of residence; the Division of Medicaid has determined, on the basis of medical advice, are needed and more readily available in your state; the location of services provided is within thirty (30) miles of the Mississippi state border for a pharmacy; or sixty (60) miles from the Mississippi state board for certain other provider types; or as determined by the Division of Medicaid.

3.  What documentation is required for an out of state provider to enroll?
     The applicant must complete the Provider Enrollment application packet located at and provide all additional items required for the requested provider type. The applicant is required to complete the Out-of-State Provider Application Cover Letter along with any requested documentation.

4.  Does the Division of Medicaid consider retroactive eligibility?
     The effective date of the provider agreement is the earliest day of the following options: the date all required screening has been completed by the Division of Medicaid (DOM) if DOM cannot verify all required screenings have been completed by a Medicare contractor or Medicaid agency or Children¿s Health Insurance Program (CHIP) of another state; up to one hundred twenty (120) days prior to the date of the submission of a Mississippi Medicaid Enrollment application if DOM can verify that the provider had all required screenings completed by a Medicare contractor or Medicaid agency or CHIP of another state; the date of Medicare certification, not to exceed three hundred and sixty-five days from the date of application, if the provider requests enrollment in the Medicaid program within one hundred twenty (120) days from the date the Medicare tie-in notice was issued to the provider; or the first day of the month in which DOM receives the provider¿s enrollment application if the provider requests enrollment after one hundred twenty (120) days of the issuance of the Medicare tie-in notice.

5.  What is the Medicare, Medicaid and CHIP detail information used for?
     If the applicant is seeking retro eligibility, the Division of Medicaid may use the results of the provider screenings performed by another state¿s Medicaid or CHIP agency in the state in which the applicant is located or by a Medicare contractor to determine the date all required screenings have been completed.

6.  Who can sign the Attestation on the Out of State Application Cover Letter?
     The attestation must be signed by the individual applicant or the Authorized Official if the application is for a group/organization. The Authorized Official is defined as an appointed official (for example, chief executive officer, chief financial officer, general partner, chairman of the board, or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicaid program, to make changes or updates to the organization¿s status in the Medicaid program, and to commit the organization to fully abide by all applicable state and federal law, regulations, policies, and requirements of the Medicaid program. The Authorized Official signs all of the documents in the application packet and is disclosed in the Provider Disclosure form.

7.  Is field 47 on the UB-04 for room and board rate or our reimbursement rate?
     You should bill your usual and customary charges. The claim will process and pay the per diem amount on your Medicaid provider file for the dates of service.

8.  How long does it take paper claims to process?
     Normal paper claims processing is 10-15 business days after Conduent receives the claims.

9.  How can I check the status of my claims?
     You may check claim status on this web site by first logging in, then selecting the Inquiry Transactions tab. You may also contact the Provider and Beneficiary Services Call Center by phone. See the Reach Us tab on the Menu Bar of the Home Page for more information.

10.  Whom do I contact if I have a question regarding electronic enrollment or need technical assistance concerning electronic claim submission?
     You may contact the Conduent EDI Support Unit Monday through Friday, 8:00 a.m. to 6:00 p.m., EST. Please see the Reach Us tab on the menu bar.

11.  What does changed code mean? Example E0202 ?
     Changes may have been made to the HCPCS code, code description, or age restrictions. For information on Misissippi Medicaid procedure codes or fees, please contact Conduent Provider and Beneficiary Services Unit.You can find there number under the Reach Us tab on the Menu bar.

12.  How long is prescription for DME good?
     Providers should consult the MS Medicaid Provider Policy Manual Section 10 concerning prescriptions and certification/recertification for DME and Medical Supplies.

13.  How far back can we go on prescriptions for DME?
     Providers should consult the MS Medicaid Provider Policy Manual Section 10 concerning prescriptions and certification/recertification for DME and Medical Supplie.

14.  Are we going to receive a fee schedule so that we will know how much we will receive for an item?
     The MS Web Portal has a downloadable fee schedule for your convenience under the provider drop down menu.

15.  Is a prescription required for glucometer replacement batteries?
     Yes, a physician prescription is required for all DME and medical supply items.

16.  What if a patient already has a glucometer?
     The MS Medicaid Provider Policy Manual Section 10.02 states that replacement of equipment may be allowed once every three (3) years if the item cannot be repaired and it is more cost effective to replace it, or if there is sufficient documentation to justify, items may be replaced more frequently.

17.  Does Medicaid now pay for alcohol prep pads? If so, when did this begin?
     Providers should refer to the MS Medicaid Provider Policy Manual Section 10.91 for policy related to coverage of alcohol prep pads.

18.  Are alcohol prep pads only covered for children?
     Effective for dates of service on and after 7/1/03, alcohol prep pads are covered for all beneficiaries.

19.  Do we still have to send our CMN as well as prescriptions?
     For DME and medical supply items except those on the waivered list, providers must submit a CMN and POC form as described in the MS Medicaid Provider Policy Manual Section 10. For items on the list of waivered DME and medical supplies related to diabetic and asthma supplies, the provider must have a physician's prescription in the beneficiary's record. A CMN form should not be submitted to eQHS for these waivered items only.

Note: HealthSystems of Mississippi (HSM) name change to eQ Health Solutions (eQHS) effective Dec. 1, 2013.

20.  Will the same modifier be used for rental of ventilators as is used for wheelchair rentals?
     Yes. Modifier RR will be used for rental.

21.  What modifier is to be used for diabetic test strips?
     Modifier SC must be used for medical supplies for claims processed.

22.  For the ostomy supplies will we still need an invoice from our vendors?
     No. Ostomy supplies are reimbursed according to the fee schedule at

23.  Are hard copy manuals available?
     All Medicaid manuals are available on the web site for the Division of Medicaid at For providers who cannot access the manuals from the internet CDs and hard copies are available from Conduent Provider and Beneficiary Services.

24.  Do diabetic prescriptions have to be renewed every 6 months or just sent to eQ Health Solutions (eQHS) every 6 months or when usage changes?
     DME and medical supply items that are NOT subject to certification requirements must be ordered by a physician. The physician's prescription is to be kept on file by the provider and is not sent to eQHS for dates of service on and after 10/1/03. The physicians prescription should be renewed every six (6) months for diabetic supplies as stated in the MS Medicaid Provider Policy Manual Section 10.90.

Note: HealthSystems of Mississippi (HSM) name change to eQ Health Solutions (eQHS) effective Dec. 1, 2013.

25.  For prior authorization on exempt items, will the provider still be limited to giving a 30-day supply?
     As stated in the MS Medicaid Provider Policy Manual Section 10.90, medical supplies may only be dispensed in quantities to meet the beneficiary's needs for one month.

26.  Are diabetic supply TANs good for 6 months?
     DME and medical supply items that are NOT subject to certification requirements must be ordered by a physician. The physician's prescription is to be kept on file by the provider and is not sent to eQHS for dates of service on and after 10/1/03. The physician's prescription should be renewed every six (6) months for diabetic supplies as stated in the MS Medicaid Provider Policy Manual Section 10.90.

Note: HealthSystems of Mississippi (HSM) name change to eQ Health Solutions (eQHS) effective Dec. 1, 2013.

27.  How will providers know if diabetic supplies have been provided and billed by another provider before the 2nd provider provides the supplies and bills? Without the prior authorization process there may be duplication of services and only one provider can be paid?
     A beneficiary must present a physician's prescription in order to obtain DME or medical supplies. If there is no prescription, DME and medical supplies should not be dispensed and duplication will be avoided in most cases.

28.  Do I have to check eligibility every time I see a Mississippi Medicaid beneficiary?
     Yes. Eligibility should be checked every time a beneficiary is seen by a Provider.

29.  How can I check a Medicaid beneficiary's eligibility?
     You can check a Medicaid Beneficiary's eligibility via the methods listed below:

Via a third party vendor hardware/software* using the Medicaid beneficiary's Identification Card (swipe card method).
Per Inquiry Transaction Charge to Provider via the Vendor.
Via the Web portal after logging in as a provider and selecting the Inquiry Transactions tab. Free to the provider.
Via the Division of Medicaid's Automated Voice Response System (AVRS).

30.  How do I request a field visit?
     You may request a field visit using this web site by first logging in, selecting the communications option and then select the "Submit a request to Customer Service" option. Once the appropriate field representative has recieved your request, you will be contacted by phone within 48 hours.

You may also contact Conduent Provider and Beneficiary Services to make your request.Please see the Reach Us tab on the menu bar for contact information.

31.  When payments are taken back, how do we know when to bill the patient or to adjust the account? Currently when payments are taken back, we do not know why and it would be helpful to know when something is being recouped and what we need to do?
     The reason code on the remittance advice (RA) provides you with information about why a claim was adjusted. The provider policy manual, section 3.09, Charges Not Beneficiary's Responsibility may be helpful in determining when a patient can be billed. The provider policy manual is available on the web site for the Division of Medicaid at Select Medicaid Provider Information from the box on the left. Then select Publications for Providers from the box on the right. Provider Manuals should be selected from the box on the left. Section 3 should be selected from the list of provider policy manual sections.

32.  On Beneficiary Eligibility response page, what is 'lock-in information'?
     Lock-in indicates that the beneficiary can receive services only from certain providers or only with authorization from that provider.

33.  Will beneficiary information through the web portal show that the beneficiary has Medicare as well as Medicaid?
     Yes. The web portal beneficiary eligibility inquiry response includes information on Medicare Part A and Part B eligibility and third party insurance.

34.  Is WINASAP5010 compatible with DSL?
     No. WINASAP5010 is dial up only. DSL or a cable modem cannot be used.

35.  Is WINASAP5010 compatible with all systems?
     To use WINASAP5010, your personal computer must meet the following minimum configuration:

Windows 98 Second Edition, Windows NT, Windows 2000 (Service Pack 3) or Windows XP operating system
Pentium processor
CD-ROM drive
25 megabytes of free disk space
128 megabytes of RAM
Monitor resolution of 800 x 600 pixels
Hayes compatible 9600 baud asynchronous modem
Telephone connectivity.

36.  We are an acute care facility, and we submit institutional and professional claims for multiple physicians. If we submit claims using WINASAP5010 how will the provider data screen be completed for each claim type?
     The provider table is completed the same for every provider you are entering. You can have multiple providers and use more than one claim type with WINASAP5010.

37.  What are the 997 and 824 downloads? Does this mean that an RA can be downloaded from WINASAP?
     The 997 and 824 are reports that are received in WINASAP to let you know the status of a claim. If the status is accepted it means the clearinghouse has accepted the claim. If the status is rejected there was a problem with the claim. If the status is errored there is a problem with data entered for the claim. You need to contact the EDI Support Unit if you have a status of rejected or errored. WINASAP cannot download an 835 or RA.

38.  Will claim status summary information be printable from WINASAP?
     There are several reports in WINASAP that can be printed. Contact the EDI Support Unit for additional information regarding reports available from WINASAP.

39.  Do we bill through WINASAP and then get our information through the web portal?
     WINASAP is used to submit claims. The web portal is used to check claims status. Claim status can be checked using the web portal for any claim regardless of how transmitted.

40.  What type of batch files are we submitting for EDI Exchange?
     The web portal will support the 270, 276, 837I, 837P and 837I transaction sets. The web portal acts solely as a pass-through mechanism for EDI transactions.

41.  How far back does the web portal go for checking eligibility?
     Eligibility is never purged, therefore, it goes back many years.

42.  Is it possible to do a Medicare/Medicaid crossover form on the web portal?
     Yes. When doing claims entry on the Web if you are wanting to do a Medicare Part A claim then select the UB04 option and the first question will ask if this is a Part A claim. If it is then select the "yes" radio button and continue with entering the claim. However, if you prefer not to enter this information over the web then the crossover forms are on the web site for the Division of Medicaid, and you can enter the information, print and submit the form with the Medicare EOB. The crossover forms can be found at: Go to provider information, select forms for providers, and then click on the form you need to use.

43.  Can we file corrected claims on the web portal when we check claim status and find a denial?
     Yes. You can resubmit the claim via the web portal under the claims options on the Provider drop down menu.

44.  What is NPI?
     The National Provider Identifier (NPI) is the standard unique health identifier for health care providers. It is a 10-digit identifier that will be used to identify health care providers in all HIPAA standard transactions. The NPI eliminates the need for health care professionals to use different numbers when conducting transactions with multiple commercial and government health plans.

45.  Who is responsible for obtaining and using an NPI?
     The NPI must be used by HIPAA covered entities which include health plans (examples: Medicare, Medicaid, and private health insurance issuers), health care clearinghouses, and health care providers (individuals and organizations) that conduct electronic transactions.

There are two types of health care providers in terms of NPIs:
Type 1 - Health care providers who are individuals, including physicians, dentists, and ALL sole proprietors. An individual is eligible for only one NPI.
Type 2 - Health care providers who are organizations, including physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself.

Organizations must determine if they have "subparts" that need to be uniquely identified in HIPAA standard transactions with their own NPIs. A subpart is a component of an organization that furnishes health care and is not itself a separate legal entity. For more information on subparts, the Centers for Medicare and Medicaid (CMS) has published a document on Medicare Subpart Expectations. This document is available on CMS' website at Once the homepage is accessed, click on the link entitled, "Medicare NPI Implementation" which is on the left-hand side of the homepage. Under downloads, click on Medicare Subpart Expectations to view the document in its entirety.
If you are an individual who is a health care provider and are incorporated, you may need to obtain an NPI for yourself (Type 1) and an NPI for your corporation or LLC (Type 2).

46.  Why am I required to obtain an NPI?
     The NPI is an Administrative Simplification mandate of HIPAA. It is one of the steps that CMS is taking to improve electronic transactions for health care and reduce the administrative burdens on health care providers.

47.  Am I required to obtain an NPI?
     The NPI compliance date is May 23, 2007. HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use ONLY the NPI to identify covered healthcare providers in standard transactions by this date. CMS recommends that providers obtain their NPI at least six months prior to this date to provide ample time to test the NPI and share it with all of their health care partners, including payers, clearinghouses, vendors, and other providers.
NOTE: Providers should not be using their NPI on HIPAA standard transactions at this time. Mississippi Medicaid providers will be able to begin using their NPI on April 27, 2007. Additional information regarding when, where, and how to use NPIs will be provided in subsequent provider bulletins.

48.  How do I obtain an NPI?
     Providers can obtain an NPI by:

Completing an on-line application at the National Plan and Provider Enumeration System (NPPES) website at ( When the homepage is accessed, the provider should click on National Provider Identifier (NPI) which is highlighted in blue. This will take the provider to the page where an online application can be completed. Or,
Contacting 1-800-465-3203 to request a paper NPI Application/Update Form and mailing the completed, signed application to the NPI Enumerator, P.O. Box 6059, Fargo, ND 58108-6059. Providers may also request a paper NPI Application/Update Form by emailing the NPI Enumerator at

49.  How do I report my NPI to Mississippi Medicaid?
     If you have obtained your NPI with the certification form the NPI Enumerator, then you are ready to report your NPI to MS Medicaid. Please prepare a facsimile cover page and include the following information in transmitting your NPI information to the Conduent Provider Enrollment fax number, 1-888-495-8169:
  1. Provider Name
  2. The name of a representative in your organization to be contacted
  3. A direct telephone number
  4. A fax number
  5. An email address
  6. NPI - Please indicate if the NPI is for an individual, group, or facility.
  7. 8 digit MS Medicaid Provider Number that corresponds to the NPI listed
  8. A servicing address which corresponds to the NPI and 8 digit Medicaid Provider Number
  9. A copy of the NPI certification form from the NPI Enumerator
You may also email the information requested above to A copy of the NPI certification form from the NPI Enumerator must be attached in the portable document format (pdf) to your email.
If facsimile transmission and email are not viable options for you, the information requested above may be mailed to: Conduent Provider Enrollment, P.O. Box 23078, Jackson, MS 39225.
Once the required information is received, the provider NPI information will be entered into the Mississippi Medicaid Management Information system (MMIS) and cross-referenced to the 8 digit Mississippi Medicaid Provider Number.
In the event one of the nine required elements stated above is omitted from the facsimile or email received, Conduent will notify the contact representative by phone, email or facsimile to obtain the necessary information to complete the NPI Medicaid enrollment process.

50.  Where can I obtain more information?
     Additional information will be published in future MS Medicaid Provider Bulletins, remittance advice banner messages, the Division of Medicaid website at, and on the MS Envision Web Portal at You may also contact Conduent Provider/Beneficiary Support at 800-884-3222 if you have questions or visit for additional information.

51.  If a patient has TPL as primary and Medicaid as secondary and TPL applies everything to deductible and Medicaid does not pay anything, can we collect from patient?
     No, Medicaid payment must be accepted as payment in full.

52.  If client has other insurance will we be able to bill electronically and then Conduent or DOM will request the insurance documentation or will we still need to submit hard copy for these?
     You will need to bill a paper claim if the third party insurance amount is less than 20 percent or if there is a denial from the third party insurance.

53.  If a claim denies for TPL edit 0750 what do I do?
     You can check the Beneficiaries TPL information by using the Eligibility Inquiry feature on the Web Portal. If the TPL information that you are looking for is not present then you can use the TPL Update feature to add additional Third Party Insurance information.

54.  What is TPL?
     TPL is an acronym for Third Party Liability. This means that a person or entity is responsible for medical expenses other than Medicaid.

55.  Who do I call to get the insurance information removed from a record?
     Contact Darlene Branson in the Bureau of Recovery at 359-6095

56.  How long does it take to update a beneficiary's insurance record?
     It takes 2 to 3 business days.

57.  Is the Medicaid recipient reponsible for their third party insuracnce co-pay or deductible?
     No. The Provider should bill the insurance plan, attach the explanation of benefits to the Medicaid claim, and Medicaid will pay up to its allowed amount.

58.  How will I know what patients have been included when a mass adjustment occurs?
     You should contact your Provider Beneficiary Relations Representative.

59.  When the third party pays the claim in full or pays more than Medicaid will allow, do I have to file a claim with Medicaid?
     Yes, this is considered an informational claim and will be used to update the history of service for the patient.

60.  Can a beneficiary have Medicaid and private insurance together?
     Yes, having private insurance does not disqualify an individual for Medicaid. However, the beneficiary is repsosible for reporting insurance changes. The private insurance in the primary payer and Medicaid is the seconday payer, or payer of last resort.

61.  Do I need to report to Medicaid that a patient no longer has insurance?
     Yes, report the changes by phone (601) 359-6095, fax (601) 359-6632 or the Web Portal. Failure to report this may delay the payment of claims.

62.  What is an Ordering, Referring or Prescribing (ORP) provider?
     42 CFR 455.410(b) of the Affordable Care Act (ACA) requires state Medicaid agencies enroll all ordering, referring or prescribing physicians and other eligible professionals providing services under the State Plan or under a waiver of the State Plan. ORP providers are physicians and other eligible practitioners, who order, refer or prescribe items or services for Medicaid beneficiaries but who choose not to submit claims to Medicaid.

63.  When is my electronic deposit available?
     Funds are transferred from the disbursement account on Wednesday night. Please contact your financial institution for availability information.

64.  How do I change my direct deposit information?
     Fill out a Direct Deposit Authorization/Agreement Form and mail it and a copy of a voided check or deposit slip to the attention of Conduent Provider Enrollment. See the Reach Us Tab on the menu bar of the Home page to view the address for Conduent Provider and Beneficiary Services.
Click HERE to download the Direct Deposit Form.

65.  Is field 47 of the UB-92 total charges or total charges less Medicaid income? Where does the resource amount need to be placed on the UB-92?
     It is total charges. Nursing facility (NF) providers do not have to include Medicaid income or resource amount on the UB-92 claim form. Medicaid income information is taken from the beneficiary file information during claims processing.

66.  Can the UB-04 manual be downloaded? How much does it cost?
     The UB-04 manual cannot be downloaded. Contact the American Hospital Association at 312-422-3000 for information about how to purchase and the price for the UB-92 manual.

67.  If patient transfers to hospital during a month, will you show this on one UB-04 or start a new one when patient returns?
     This will depend upon how many days the patient is in the hospital. If the hospital stay is 15 days or less, the patient is not discharged from the hospital and this is on one UB-04 claim form. If the patient is discharged from the NF for more than 15 hospital days, but is readmitted to the NF, a 2nd UB-92 claim form is needed.

68.  What do we do if they have a resident that has 2 hospital stays in one month and comes back to our facility as a hospice patient? Can this be billed on one UB-92 claims form?
     When the resident is admitted to hospice, s/he is discharged from the NR and the hospice provider bills for the hospice days.