ProviderOne Billing and Resource Guide

About the guide

The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff:

• Find client eligibility for services.
• Bill in a timely fashion.
• Receive accurate payments for covered services.

The guide is intended to:

• Strengthen the current instructions that apply to nearly all types of providers.
• Respond to provider requests for more step-by-step reference materials for ProviderOne.

Appendixes

The appendixes below are included in the complete guide. They are presented here for your convenience.

Appendix A - Use interactive voice response (IVR) to verify eligibility

Appendix B - Verifying eligibility using a magnetic card reader or MEV service

Appendix C - Managed care organizations (MCOs)

Appendix D - Casualty claims and health insurance claims

Appendix E - Benefit services packages

Appendix F - Instructions to fill out the General Information for Authorization Request form

Appendix G - How to check status of an authorization

Appendix H - Cover sheets for backup documentation

Appendix I - Taxonomy and ProviderOne 

Appendix J - Medicare crossover claim payment methodology

Appendix K - Checking claim status with IVR 

Appendix L - Checking warrants with IVR

Paperless billing at HCA

On October 1, 2016, we implemented a paperless billing policy where all Apple Health (Medicaid) providers (excluding Tribal billing offices) are required to submit electronic claims for Apple Health (Medicaid) services. Providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically. 

The agency's Provider Relations team hosted two webinars focused on billing electronically through the ProviderOne portal to assist those providers who have not transitioned to electronic billing. The links to these webinars, the waiver form, and an FAQ on the paperless policy can be accessed below:

• Direct Data Entry (DDE) webinar for billing dental claims
• Direct Data Entry (DDE) webinar for billing professional claims
• Request a Waiver from Electronic Billing
• Elimination of Paper Claims frequently asked questions
• How to resubmit a paper claim using ProviderOne
• Paper Claim Billing Resource for providers approved to continue paper billing

Provider billing guides and fee schedules

Use the provider billing guides and rates and fee schedules as companions to the billing and resource guide. You will use these regularly as you submit your claims.

• Professional rates, fee schedules, and billing guides
• Hospital reimbursement

Sign up for notifications

Stay informed! Sign up for HCA's Provider Alerts to learn about changes to rates and updates to our billing guides.