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Hospitals Information - FAQ

Hospitals FAQs

  1. 1.  Is there a deadline for submitting electronic claims?
    • Electronically submitted claims (i.e., claims submitted using billing software or via a clearinghouse), must be transmitted by 3:00 pm on Fridays to ensure processing in weekly payment cycle. For assistance and questions regarding electronically submitted claims, please contact Conduent’s EDI Department at (866) 407-2005.

  2. 2.  Why use the Web Portal?
    • Providers and their staff can conveniently and efficiently access health-related information for a 24 hours a day via the Web Portal. The web portal has many key features that is beneficial to its users. A few of the key features include the ability to verify recipient eligilibity, check claim status regardless of method of submission, obtain payment information and download Remittance Advices.

  3. 3.  How frequently is the fee schedule updated?
    • The fee schedule is systemically updated weekly.  If you have questions, contact Provider Inquiry at (202) 906-8319 (inside DC metro area) or (866) 752-9233 (outside DC metro area) or via email at providerinquiry@conduent.com.

  4. 4.  Will the review by Comagine (formerly Qualis) include OB deliveries?
    • Vaginal deliveries and unplanned C-sections will not require an authorization.

  5. 5.  Will secondary insurance require admission review by Comagine (formerly known as Qualis)?
    • If Medicaid is not the primary payer on admission, then no authorization is required.

  6. 6.  Who is the contact person at Comagine (formerly Qualis) that the hospitals will be directly communicating with for continuity of communications, especially if there are denials?
    • Calls will be directed to appropriate Comgaine (formerly Qualis) reviewers specifcally assigned to assist you with issues related to denials. Should you have problems receiving authorization after following appropriate procedures, you may call the Comagine Preauthorization number at (800) 251-8890 or email dcmedicaid@qualishealth.org.

  7. 7.  If a provider fails to provide information for the initial review for Comagine (formerly known as Qualis), will the entire stay be denied?
    • Yes. Should a provider fail to provide the clinical information for the ER Admission Review, the entire stay referenced on the submitted claim will be denied due to lack of a timely request for authorization.

  8. 8.  We are having trouble using the online web portal, who can help?
    • Registration and navigational instructions for the web portal can be found on the left-hand side of the web portal under the heading “Training Material/CBT”. Please review the Web Portal Quick Reference Guide for instructions.  

      If you need additional help, contact the Conduent Provider Inquiry line at (202) 906-8319 (inside DC metro area) or (866) 752-9233 (outside DC metro area) or via email at providerinquiry@conduent.com.