Problem: Information in the Guilford Center computer has not properly transmitted to the IPRS computer in Raleigh: IPRS does not recognize this consumer.
Solution: You do not need to do anything; Guilford Center staff will correct the discrepancy. Contact Provider Help Desk if there is no payment on the next EOB.

Problem: This consumer does not exist in the IPRS computer in Raleigh.
Solution: Guilford Center staff will cross reference the consumer to the IPRS computer. Contact Provider Help Desk if there is no payment on the next EOB.

Problem: This is a duplicate of a claim already paid.
Solution: This is usually a one-time error in computer billing at The Guilford Center, and no action is necessary. If your agency has actually done two identical services on the same day for the same consumer, contact Provider Help Desk.

Problem: Consumer has private insurance. Medicaid will not pay until private insurance pays or denies.
Solution: Confirm insurance coverage from consumer and bill insurance company. If insurance makes a partial payment, send insurance EOB with a paper invoice to Accounts Receivable. Medicaid will pay the remainder. If company does not cover service or diagnosis or denies for any legitimate reason, send EOB with a paper invoice to Accounts Receivable. Medicaid will pay. (Medicaid will not pay if insurance denies because provider is out of network or because provider failed to get prior approval.)

Problem: Consumer is eligible for both Medicare and Medicaid. Medicaid will not pay until Medicare pays first.
Solution: If you are a Medicare provider, bill Medicare. If you are not a Medicare provider, there are some circumstances where Medicaid will pay directly. Contact the Provider Help Desk for information.

Problem: This is generally a discrepancy between the Guilford Center computer and the IPRS computer in Raleigh where the IPRS population has not properly transmitted.
Solution: Guilford Center staff will correct the error; you do not need to do anything. Contact Provider Help Desk if there is no payment on the next EOB.

Problem: This is a payment in full. Medicaid has reduced the payment in accordance with the credentials of the provider.
Solution: None; this is payment in full.

Problem: Usually the diagnosis does not justify the population assignment or (rarely) the service is not in the array of service for the IPRS population. (Example: the consumer’s IPRS population is AMSMI but the only primary diagnosis is 311. That diagnosis does not support the population assignment.)
Solution: Guilford Center staff will contact you with specific advice on how to correct the error or you can be proactive and make sure the diagnosis is correct and supports the population.

Problem: IPRS populations have expired.
Solution: Update the IPRS population on The Guilford Center Admission Form and email it to:  Fees&Admit@guilfordcenter.com  The form is available at www.guilfordcenter.com/provider/forms/default.htm