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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
A Good Faith claim is a claim that has been denied by Medicaid with an eligibility-related Explanation of Benefits ( EOB ) code. This occurs even though the provider verified eligibility for the dates of service billed and submitted a correct and complete claim. Providers can resubmit the claim to EDS to be processed as a Good Faith claim. If the eligibility file has been updated by the time the claim is resubmitted, it will be paid automatically. If the file still does not reflect eligibility for the period covered by the claim, EDS will try to resolve the eligibility discrepancy. If they are unable to resolve it from the information available, they will contact you to verify eligibility. The Good Faith form ( HCF 10111 ) is used for this purpose. A Good Faith claim cannot be reimbursed until the EDS recipient file is updated.
This page last updated in Release Number: 01-02
Release Date: 04/01/01
Effective Date: 04/04/01
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