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How to use DDE: Professional Billing How to use DDE Professional Billing.

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Presentation on theme: "How to use DDE: Professional Billing How to use DDE Professional Billing."— Presentation transcript:

1 How to use DDE: Professional Billing How to use DDE Professional Billing

2 Log on Go to 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) How to use DDE: Professional Billing

3 How to use DDE: Professional Billing

4 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”. How to use DDE: Professional Billing

5 Header: Submitter Information How to use DDE: Professional Billing

6 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 Name/Telephone number –Enter name and phone number of the person who is billing How to use DDE: Professional Billing

7 Header: Billing Provider How to use DDE: Professional Billing

8 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 How to use DDE: Professional Billing

9 Header: Subscriber Information How to use DDE: Professional Billing

10 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 –Gender How to use DDE: Professional Billing

11 Header: Claim Information How to use DDE: Professional Billing

12 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 How to use DDE: Professional Billing

13 Header: Admission and File Info How to use DDE: Professional Billing

14 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 How to use DDE: Professional Billing

15 Header: PA/EPSDT Referral How to use DDE: Professional Billing

16 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 How to use DDE: Professional Billing

17 How to use DDE: Professional Billing Header: Diagnosis Codes

18 How to use DDE: Professional Billing Diagnosis Codes Principal Diagnosis Information –Enter the primary diagnosis code –Do not include the decimal –Example: if DX is ; enter Other Diagnosis Information –Enter additional diagnosis codes if applicable

19 How to use DDE: Professional Billing Header: Referring/Service Facility

20 How to use DDE: Professional Billing 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

21 How to use DDE: Professional Billing COB: Other Subscriber

22 How to use DDE: Professional Billing 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

23 How to use DDE: Professional Billing COB: Other Subscriber Cont.

24 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 Gender How to use DDE: Professional Billing

25 COB: Other Payer How to use DDE: Professional Billing

26 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 How to use DDE: Professional Billing

27 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 How to use DDE: Professional Billing

28 COB Once Added to Claim How to use DDE: Professional Billing

29 Services: Add Service to Claim How to use DDE: Professional Billing

30 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 How to use DDE: Professional Billing

31 Services: Service Date/NDC Info How to use DDE: Professional Billing

32 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 How to use DDE: Professional Billing

33 Services: Rendering Provider How to use DDE: Professional Billing

34 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 How to use DDE: Professional Billing

35 Services: NET Provider How to use DDE: Professional Billing

36 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 How to use DDE: Professional Billing

37 Services: Adding the Service How to use DDE: Professional Billing

38 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


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