1. How to Use DDE Professional Billing for Alternative Care Providers

2. How to use DDE: Professional Billing for Alternative Care

3. Go to www.medicaid.state.ar.uswww.medicaid.state.ar.us Click on “Provider” Click on “Log on” Enter the provider’s 9-digit Medicaid ID number (PIN) as the User ID –The setup password is the provider’s SSN (will be prompted to change) Click the Submit button How to use DDE: Professional Billing for Alternative Care Log On

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 for Alternative Care

5. Header: Submitter Information How to use DDE: Professional Billing for Alternative Care

6. Entity Type –Enter person Last/Organization Name/First Name –Enter the Provider last and first name Electronic Transmitter ID –Enter eight zeroes: 00000000 Name/Telephone number –Enter your name and phone number, including area code How to use DDE: Professional Billing for Alternative Care Submitter

7. How to use DDE: Professional Billing for Alternative Care Header: Billing Provider

8. Medicaid Provider ID/NPI –Enter the provider’s Medicaid ID number and leave the NPI field blank How to use DDE: Professional Billing for Alternative Care Billing Provider

9. How to use DDE: Professional Billing for Alternative Care Header: Subscriber Information

10. Enter the beneficiary’s information –Last Name –First Name –Middle Name (not required) –Medicaid beneficiary ID number –Address, including City, State, Zip –Birth Date Format is MMDDYYYY If DOB is 01/01/2010, enter 01012010 –Gender How to use DDE: Professional Billing for Alternative Care Subscriber

11. How to use DDE: Professional Billing for Alternative Care Header: Claim Information

12. Patient Account Number –12345 Place of Service –Place of service - Enter 12 How to use DDE: Professional Billing for Alternative Care Claim Information

13. How to use DDE: Professional Billing for Alternative Care Header: Diagnosis Codes

14. 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 How to use DDE: Professional Billing for Alternative Care Diagnosis Codes

15. How to use DDE: Professional Billing for Alternative Care Services: Add Service to Claim

16. Procedure –Enter S5125 Charge –The dollar amount that you are billing. Using the Pay Grid that follows, enter the Billing Amount for the hours you worked. Quantity –Units of time that you worked. Using the Pay Grid that follows, enter the Units Worked for the hours you worked. Diagnosis Code Pointer –Enter 1 How to use DDE: Professional Billing for Alternative Care Add Service to Claim

17. Pay Grid Hours Worked (15 min. increments) Units WorkedBilling Amount (Units X $2.43) 15 mins1$2.43 30 mins2$4.86 45 mins3$7.29 1 hr4$9.72 1 hr, 15 mins5$12.15 1 hr, 30 mins6$14.58 1 hr, 45 mins7$17.01 2 hrs8$19.44 2 hrs, 15 mins9$21.87 2 hrs, 30 mins10$24.30 2 hrs, 45 mins11$26.73 3 hrs12$29.16 3 hrs, 15 mins13$31.59 3 hrs, 30 mins14$34.02 How to use DDE: Professional Billing for Alternative Care Use this table to complete your AAS-9559. Find the hours you work at one time. Then enter the Units Worked and the Billing Amount on the AAS-9559. Example: You work 2 hours and 15 minutes one day. On the AAS-9559, enter 9 units worked and $21.87 for the billing amount.

18. Pay Grid How to use DDE: Professional Billing for Alternative Care Hours Worked (15 min. increments) Units WorkedBilling Amount (Units X $2.43) 3 hrs, 45 mins15$36.45 4 hrs16$38.88 4 hrs, 15 mins17$41.31 4 hrs, 30 mins18$43.74 4 hrs, 45 mins19$46.17 5 hrs20$48.60 5 hrs, 15 mins21$51.03 5 hrs, 30 mins22$53.46 5 hrs, 45 mins23$55.89 6 hrs24$58.32 6 hrs, 15 mins25$60.75 6 hrs, 30 mins26$63.18 6 hrs, 45 mins27$65.61 7 hrs28$68.04 7 hrs, 15 mins29$70.47 7 hrs, 30 mins30$72.90 7 hrs, 45 mins31$75.33 8 hrs32$77.76

19. How to use DDE: Professional Billing for Alternative Care Services: Service Date/NDC Info

20. Service Date Period (first day worked) –Enter the From and To date of service – (1 day) – same date –Format is MMDDYYYY –If the date of service is 1/1/2010, enter 01012010 –Click Add How to use DDE: Professional Billing for Alternative Care Services: Service Date/NDC Info

21. Services: Adding the Service How to use DDE: Professional Billing for Alternative Care

22. 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. Click Submit How to use DDE: Professional Billing for Alternative Care Adding Service (Additional Days) on Claim/Submit Claim