EDI Claims Statusing

EDI Claims Statusing On The HAP Midwest Health Plan Website

EDI Claims Statusing is provided for all HAP Midwest Health Plan providers.  EDI Claims Statusing can be tracked 24/7 on website at www.midwesthealthplan.com. Midwest Health Plan EDI Claims Statusing gives you the possibility to status up to three years of claims data.

EDI Claims Statusing procedure

  • Click on Provider Services
  • Click on Claims
  • Click on Inquiry, then select Professional or Institutional claim type to status your claim.

You have many options on how to extract the data. For best search results and speed, use “Patient’s Account#” with “date of service.”

For your convenience, all the pertinent legends for code explanations are located on the same page above the claims link labeled “HAP Midwest Health Plan Remittance Advice Legend.” They are the same ones used for the Remittance Advices.

Providers who are able to logon to HAP Midwest Health Plan’s secure site can search for claims submitted by them based on the billing TAX ID on the claim.
For contracted providers, this login is the same one used currently for downloading Remittance Advice reports for CAP, Claim, and P4P.

Adjucation/Payment Procedure

All claims and encounters submitted to HAP Midwest Health Plan are date stamped on the day received. HAP Midwest Health Plan processes clean claims and encounters within 45 days of receipt.
  1. Payment for all non-capitated, authorized, medically necessary services are paid at current Medicaid fee screens. Contracted rates supersede this statement.
  2. HAP Midwest Health Plan’s payment of covered Medicaid services is considered Medicaid payment in full. It is against the law to bill a Medicaid member for covered services.
  3. HAP Midwest Health Plan makes payments bi-weekly and a special check run on the last working day of each quarter for quarter ending.
  4. Checks are mailed within two working days from the check date.
  5. Remittance advices for the payments are available in PDF format on HAP Midwest Health Plan’s website for three months and can be downloaded for your convenience.
  6. If you need further assistance, contracted providers must call your Provider Relations Representative and Non-contracted providers must call the Claims Department at (888) 654-2200, Prompt 2, then Prompt 2 again.
  7. Remittance advice provides information specifying member and claim (form#) being paid and rejection information if applicable. Encounter data also appears on the remittance advice, but will be flagged with “C” for Capitated Services and will not be included in any payments.

To learn more about healthcare EDI and become a certified EDI Professional please visit our course schedule page.

Leave a Reply

Your email address will not be published.

Post Navigation