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6.1.2 Automated Inquiry System Appeals
The following appeals may be submitted using AIS:
• Client Eligibility. The client's correct Medicaid number, name, and date of birth are required.
•Provider Information (Excluding Medicare Crossovers). The correct provider identifier is required for the billing provider, performing provider, referring provider, and limited provider. The name and address of the provider are required for the facility and outside laboratory.
•Claim Corrections. Providers may correct the following:
•Patient control number (PCN).
•Date of birth.
•Date of onset.
•X-ray date.
•Place of service (POS).
•Quantity billed.
•Prior authorization number (PAN).
•Beginning date of service.
•Ending date of service.
•The following appeals may not be appealed through AIS:
•Claims listed on the R&S report as Incomplete Claims.
•Claims listed on the R&S report with $0 allowed and $0 paid.
•Claims requiring supporting documentation (for example, operative report, medical records, home health, hearing aid, and dental X-rays).
•DRG assignment.
•Procedure code, modifier, or diagnosis code.
•Medicare crossovers.
•Claims listed as pending or in process with EOPS messages.
•Claims denied as past filing deadline except when retroactive eligibility deadlines apply.
•Claims denied as past the payment deadline.
•Inpatient Hospital claims requiring supporting documentation.
•Third party resource (TPR)/Other insurance.
Providers may appeal these denials either electronically or on paper.
Refer to: "Disallowed Electronic Appeals" to determine if these appeals can be billed electronically. If these appeals cannot be billed electronically, a paper claim must be submitted. Exception: Inpatient hospital claims denied for lack of a Hysterectomy Acknowledgment Statement or a Sterilization Consent Form may be appealed if the requested form has been faxed according to the instructions under "Hysterectomy Services" .
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