1. How to use DDE
Professional Billing

2. Log on Log on will always be the providers 9-digit Medicaid id number.
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. To start a new claim click on “Professional Claim”.
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 Last/Organization Name/First Name
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 Facility Code Value
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 EPSDT Referral
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. Header: Diagnosis Codes
How to use DDE:
Professional Billing

18. Diagnosis Codes Principal Diagnosis Information
Enter the primary diagnosis code
Do not include the decimal
Example: if DX is ; enter 11111
Other Diagnosis Information
Enter additional diagnosis codes if applicable
How to use DDE:
Professional Billing

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

20. 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
How to use DDE:
Professional Billing

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

22. 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
How to use DDE:
Professional Billing

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

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 ID Original Ref. number (Medicare Only)
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 Modifiers (if applicable)
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