how to use dde: professional billing how to use dde professional billing

How to use DDE:Professional Billing

How to use DDEProfessional Billing

Log on• Go to www.medicaid.state.ar.us• Click on Provider• Click on Log On

– Log on will always be the providers 9-digit Medicaid id number.

– Initial password for individual provider number• Provider’s SSN (Will be prompted to change)

– Initial password for group/facility• Provider’s Tax ID number (Will be prompted to

change)


http://www.medicaid.state.ar.us/

Once you are logged on your provider name will appear under “Welcome Back”.

To start a new claim click on “Professional Claim”.To void or adjust a previous claim click on “Professional Claim reversal”.


Header: Submitter Information


Submitter

• Entity Type– Individual Providers: enter Person– Group/Organization: enter Non-Person

• Last/Organization Name/First Name– Group provider not required to complete first name– Individual Provider must complete both last and first name

• Electronic Submitter ID– Enter Medicaid Submitter ID number– If unknown, may enter 88888888

• Name/Telephone number– Enter name and phone number of the person who is billing


Header: Billing Provider


Billing Provider

• The billing provider’s name, SSN/Tax ID, and address will already appear in this section

• Medicaid Provider ID/NPI– Medicaid Provider ID should be left blank unless the provider is not

required to have an NPI number. In this case enter the provider’s Medicaid ID # and leave the NPI field blank.

– All other providers are required to use their NPI number for electronic claims.

• Taxonomy– Only enter if required


Header: Subscriber Information


Subscriber

• Enter the recipient’s information– Last Name– First Name– Middle Name (not required)– Medicaid ID number– Address– Date of Birth

• Format is MMDDYYYY• If DOB is 01/01/2010 enter as 01012010

– Gender


Header: Claim Information


Claim Information• Patient Account Number

– Number assigned by the provider

• Facility Code Value– Place of service

• Date Last seen/Onset of Current Illness – Not Required

• Claim Frequency Type Code– Original Claim, Replacement, or Void of prior claim

• Related Causes Code– Only if services were related to auto accident, employment, etc.

• Special Program Code– Select EPSDT from drop down box if an EPSDT Screening was

performed


Header: Admission and File Info


Admission and File Information

• Admission Date– Date of admission

• File Information– Enter a valid Therapy Service Code, if required (refer to section II of the

provider manual to determine which code is appropriate)– Enter School District Code if required

• Schools LEA Code

• Claim Supplemental Information– Currently not used


Header: PA/EPSDT Referral


PA/EPSDT Referral

• Prior Authorization Number– Only required if procedure needs a PA– Only one PA per claim

• EPSDT Referral– Certification Condition Indicator: check if a result of an EPSDT

screening– Condition Codes currently not used



Header: Diagnosis Codes


Diagnosis Codes

• Principal Diagnosis Information – Enter the primary diagnosis code – Do not include the decimal– Example: if DX is 111.11; enter 11111

• Other Diagnosis Information– Enter additional diagnosis codes if applicable


Header: Referring/Service Facility


Referring/Service Facility

• Referring Provider (PCP-if required)– Enter provider’s Last and First name– NPI number– Taxonomy, if applicable for the provider

• Service Facility Location – Enter when place of service is 21 or 22– Enter facility’s name, address, and NPI number


COB: Other Subscriber


Other Subscriber

• COB only required if recipient has Medicare or commercial insurance coverage

• Payer Responsibility– Choose Primary or Secondary

• Individual Relationship Code– Beneficiary’s relationship to the policy holder

• Insured Group/Policy number/Policy Name• Claim Filing Indicator

– Choose Medicare or Commercial

• Benefits Assignment/Release of Information– Yes or No


COB: Other Subscriber Cont.

Other Subscriber Cont.

• Last and First Name of policyholder • Member ID number• Address• Date of birth

– Month, Day, Year format– If DOB is 01/01/2010 enter as 01012010

• Gender


COB: Other Payer


Other Payer

• Organization Name– Enter Commercial or MedicareB

• ID– For Commercial: enter C1– For Medicare B: enter MO2

• Original Ref. number (Medicare Only)– Enter the Medicare ICN (claim) number

• Adjudication Date– For Medicare: enter the date claim processed– For Commercial: enter the date claim denied if applicable


Other Payer Cont.

• Adjustments for Medicare Insurance– Deductable Amount, if applicable– Coinsurance Amount, if applicable– Allowed Amount– Paid Amount, if applicable

• Adjustments for Other Insurance– Enter the amount commercial insurance paid, if applicable

• Click the Add button to add the information to the claim– Once the information is added it will add it to the top of the COB. See

next slide for example


COB Once Added to Claim


Services: Add Service to Claim


Add Service to Claim

• Procedure– Enter the 5 digit procedure code

• Modifiers (if applicable)• Charge (for the total line item)• Quantity

– Units or minutes and how many

• Facility Code (not required for this screen)• Diagnosis Code Pointer

– Points diagnosis code to procedure

• Emergency/EPSDT/Family Planning Indicator– Only if applicable


Services: Service Date/NDC Info


Service Date/NDC Info

• Service Date Period– Enter the From and To date of service

• Provider Control Number (not required)• Universal Product Number (not required)• DDS Funding Code

– Only required for DDS providers

• Drug Information– Required when billing for NDC numbers– Enter NDC number (11 digits) and quantity


Services: Rendering Provider


Rendering Provider

• If billing under Individual Provider, not required• If billing under a Group Provider, it is required• Provider’s Last and First Name• Provider’s NPI Number• Taxonomy only if applicable


Services: NET Provider


NET Provider

• Required only for NET providers• Indicate yes or no

– Destination Provider– Request date– Transportation Mode– Appointment after hours– Within service region– Others riding– Times– Click Add button once all information is completed


Services: Adding the Service


Adding Service/Submit Claim

• Once you click the Add button, it will add your service to the top of the screen

• Once you have added the service you can add a second service, third service, etc….

• The Submit button will turn red once you have added at least one service. When the submit button is red you may submit your claim whenever you are ready.


how to use dde: professional billing how to use dde professional billing

Documents

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