Fact sheets

Claim submission

• Balance billing prohibition
• Save and retrieve a claim (using DDE)
• Hospice providers: reporting nursing home NPI numbers on claims
• Creating templates and submitting a template claim
• How to make billing orthodontics easy
• How to read EOB codes
• How to bill with two authorization numbers
• Institutional type of bill codes for direct data entry (different than standard codes)

Client eligibility

• Successful eligibility checks using ProviderOne
• Client benefit limit inquiry (in ProviderOne)
• Provider spenddown step by step

Provider referrals

• Removing a provider's name from the list of providers accepting new patients
• FAQ for local jails and prescriber enrollment requirements
• FAQ on the Medicaid requirements for ordering, prescribing, and referring providers
• Provider inquiry in ProviderOne

Billing with commercial insurance or Medicare as primary

• Reporting Medicare/Managed Medicare and commercial payer data on an 837 transaction
• Submitting professional crossover claims with secondary insurance
• DDE Medicare crossover claims for 5010

Taxonomy

• Taxonomy in ProviderOne
• Submitting institutional and Rural Health/FQHC claims to Medicare with a taxonomy code
• Submitting professional services claims to Medicare with a taxonomy code