provider type 14 billing guide

( Share sensitive information only on official, secure websites. View the complete guide. Subsequent requests for concurrent review are to be submitted on FA-14. endobj The links to these webinars, the waiver form, and an FAQ on the paperless policy can be accessed below: Use the provider billing guides and rates and fee schedules as companions to the billing and resource guide. The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: Find client eligibility for services. Acute Inpatient Prospective Payment System (IPPS) Hospital; Ambulance; . Medical Assistance Customer Service Center (MACSC)Online: secure formPhone: 1-800-562-3022, Website feedback: Tell us how were doing, Copyright 2022 Washington Health Care Authority, I help others apply for & access Apple Health, Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. Date: 12/05/18. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Federally Qualified Health Centers (FQHC), HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical Center Payment System Final Rule, CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule with Comment Period (CMS 1772-FC), CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1772-FC) Rural Emergency Hospitals New Medicare Provider Type. For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. If this occurs, please refer to the most recent guide. !U#yMDFNyH]Q&GB72XH(R4dLL*F[ryDmH2e6:VbWF&.R*\i,#sX@DFA((:A Qa. Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z. See Physician-related/professional services for information regarding vision exams and related services. Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation. OnOctober 1, 2016, we implemented a paperless billing policy where all Apple Health (Medicaid) providers (excluding Tribal billing offices) are required to submitelectronic claims for Apple Health (Medicaid) services. The Fee-For-Service Provider Billing Manual provides detailed information for those applying for AHCCCS (applicants), members, potential and existing providers. 14 Podiatrist 140 Podiatrist 15 Chiropractor 150 Chiropractor 16 Nurse 160 Registered Nurse Nursing Home Providers. Diagnostic (continued) 96116 . For telehealth policies and FAQs, see Telehealth on this page. Nursing services, physician services, and drugs and biologicals must Home Health. Rural Health Clinics (RHC) and Federally Qualified Health (FQHC) Ground Ambulance Upper Payment Limit (UPL) Secure .gov websites use HTTPSA website belongs to an official government organization in the United States. Learn about changes to rates and updates to our billing guides. .gov Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., Type Code Provider Type Desc Specialty Code Specialty Desc 01 Inpatient Facility 010 Acute Care Hospital 01 Inpatient Facility 011 Private Psychiatric Hospital 01 Inpatient Facility 012 Inpatient Medical Rehab Hospital . It contains information on all of the below: Noridian Phone and Contact Information Join Noridian Medicare Email List 1 Day Payment Window 3 Day Payment Window An invoice, bill or tab is a commercial document issued by a seller to a buyer relating to a sale transaction and indicating the products, quantities, and agreed-upon prices for products or services the seller had provided the buyer.. Payment terms are usually stated on the invoice. 678 0 obj <>/Filter/FlateDecode/ID[<460207C96267AC43B00704173EA05454>]/Index[648 72]/Info 647 0 R/Length 121/Prev 128865/Root 649 0 R/Size 720/Type/XRef/W[1 2 1]>>stream All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL. 648 0 obj <> endobj This provider type was last subject to a rate review* on : 11/2016 Note: Specialty Proc Mod Desc Rate Rate Begin Date 300 90785 Psytx complex interactive 4.40 1/1/2013 300 90791 Psych diagnostic evaluation 139.46 1/1/2013 300 90792 Psych diag eval w/med srvcs 113.76 1/1/2013 300 90832 PSYTX W PT 30 MINUTES 57.78 1/1/2013 Enrollment as a Medicaid provider includes completion of an online application and uploading supporting documentation ( i.e., W9's, licensure/certification information and other information specific to the type of provider). 1 Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment State policy The Medicaid Services Manual (MSM) is on the Division of Health Care Financing and policy (DHCFP) website at (select Manuals from the Resources webpage). For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. lock Questions? The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: The appendixes below are included in the complete guide. Some organizational providers are required to pay an application fee. 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. Stay informed! 4 0 obj View nv_billingguidelines_pt14.pdf from FRE 212 at Northern Virginia Community College. Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. Official websites use .govA For outpatient and other Part B services, the UPIN must be present if the "From" date is January 1, 1992, or later. This guide was discontinued July 1, 2020. Please choose the appropriate provider type or specialty below to view the PROMISe handbook and billing guide appropriate for you. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process. hbbd``b`^$[u bv $XAJtA Ab| +9bu nw,`[$@F) Nk+d+j%#88o _e The request See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. Provider Types. (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. . endobj Fax the request to: 866-668-1214. August 1, 2022 to present Neurodevelopmental centers billing guide, July 1, 2022 to July 31, 2022 Neurodevelopmental centers billing guide, July 1, 2021 to June 30, 2022 Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, July 1, 2022 to present Neurodevelopmental centers fee schedule, July 1, 2021 to June 30, 2022 Neurodevelopmental centers fee schedule, January 1, 2021 to June 30, 2021 Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment billing guides, July 1, 2018 to December 31, 2018 Nondurable medical supplies and equipment billing guides, View all nondurable medical supplies and equipment billing guides, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment fee schedule, October 1, 2022 to present Nursing facilities billing guide, July 1, 2022 to September 30, 2022 Nursing facilities billing guide, April 1, 2022 to June 30, 2022 Nursing facilities billing guide, View all nursing facilities billing guides, October 1, 2022 to present Orthodontic services billing guide, July 1, 2022 to September 30, 2022 Orthodontic services billing guide, June 1, 2022 to June 30, 2022 Orthodontic services billing guide, View all orthodontic services billing guides, August 1, 2022 to present Outpatient hospital services billing guide, July 1, 2022 to July 31, 2022 Outpatient hospital services billing guide, April 1, 2022 to June 30, 2022 Outpatient hospital services billing guide, October 1, 2022 to present OPPS fee schedule, July 1, 2022 to September 30, 2022 OPPS fee schedule, April 1, 2022 to June 30, 2022 OPPS fee schedule, January 1, 2022 to March 31, 2022 OPPS fee schedule, October 1, 2021 to December 31, 2021 OPPS fee schedule, August 1, 2022 to present Outpatient rehabilitation billing guide, July 1, 2022 to July 31, 2022 Outpatient rehabilitation billing guide, January 1, 2022 to June 30, 2022 Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, July 1, 2022 to present Outpatient rehabilitation fee schedule, July 1, 2021 to June 30, 2022 Outpatient rehabilitation fee schedule, January 1, 2021 to June 30, 2021 Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, July 1, 2022 to present Pharmacy Special Services fee schedule, July 1, 2021 to June 30, 2022 Pharmacy Special Services fee schedule, July 1, 2020 to June 30, 2021 Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, October 14, 2022 to present Physician-related services/health care billing guide, October 1, 2022 to October 13, 2022 Physician-related services/health care billing guide, August 1, 2022 to September 30, 2022 Physician-related services/health care billing guide, View all physician-related/professional services billing guides, October 1, 2022 to present Physician-related services fee schedules, July 1, 2022 to September 30, 2022 Physician-related services fee schedules, April 1, 2022 to June 30, 2022 Physician-related services fee schedules, View all physician-related/professional services fee schedules, July 1, 2022 to present Enhanced pediatric fee schedule, October 1, 2021 to June 30, 2022 Enhanced pediatric fee schedule, July 1, 2021 to September 30, 2021 Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, July 1, 2022 to present Enhanced adult primary care fee schedule, October 1, 2021 to June 30, 2022 Enhanced adult primary care fee schedule, July 1, 2022 to present Opioid use disorder fee schedule, July 1, 2021 to June 30, 2022 Opioid use disorder fee schedule, January 1, 2021 to June 30, 2021 Opioid use disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2022 to present Conversion factors, July 1, 2021 to June 30, 2022 Conversion factors, July 1, 2020 to June 30, 2021 Conversion factors, Centers of Excellence: organ transplant facilities directory, October 1, 2022 to present Planned home births and births in centers billing guide, June 11, 2022 to September 30, 2022 Planned home births and births in centers billing guide, April 1, 2022 to June 10, 2022 Planned home births and births in centers billing guide, View all planned home births billing guides, July 1, 2022 to present Planned home births and births in centers fee schedule, July 1, 2021 to June 30, 2022 Planned home births and births in centers fee schedule, July 1, 2020 to June 30, 2021 Planned home births and births in centers fee schedule, View all planned home births fee schedules, July 1, 2022 to present Prenatal diagnosis genetic counseling fee schedule, July 2021 to June 30, 2022 Prenatal diagnosis genetic counseling fee schedule, July 1, 2020 to June 30, 2021 Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, April 1, 2022 to present Prescription drug program billing guide, October 1, 2021 to March 31, 2022 Prescription drug program billing guide, September 1, 2021 to September 30, 2021 Prescription drug program billing guide, June 1, 2022 to present Expedited authorization codes and criteria table, December 1, 2021 to May 31, 2022 Expedited authorization codes and criteria table, July 1, 2021 to November 30, 2021 Expedited authorization codes and criteria table, July 1, 2022 to present Private duty nursing for children billing guide, October 1, 2020 to June 30, 2022 Private duty nursing for children billing guide, July 17, 2020 to September 30, 2020 Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2020 to present Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 Private duty nursing fee schedule, October 1, 2022 to present Professional administered drug fee schedule, July 1, 2022 to September 30, 2022 Professional administered drug fee schedule, April 1, 2022 to June 30, 2022 Professional administered drug fee schedule, View all professional administered drugs fee schedules, July 1, 2022 to present Prosthetic and orthotic devices billing guide, April 1, 2022 to June 30, 2022 Prosthetic and orthotic devices billing guide, October 1, 2021 to March 31, 2022 Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, July 1, 2022 to present Prosthetic and orthotics fee schedule, October 1, 2021 to June 30, 2022 Prosthetic and orthotics fee schedule, July 1, 2021 to September 30, 2021 Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, August 1, 2022 to present Respiratory care billing guide, July 1, 2022 to July 31, 2022 Respiratory care billing guide, October 1, 2021 to June 30, 2022 Respiratory care billing guide, July 1, 2022 to present Respiratory care fee schedule, October 1, 2021 to June 30, 2022 Respiratory care fee schedule, July 1, 2021 to September 30, 2021 Respiratory care fee schedule, October 1, 2022 to present Rural health clinics billing guide, August 1, 2022 to September 30, 2022 Rural health clinics billing guide, July 1, 2022 to July 31, 2022 Rural health clinics billing guide, October 1, 2022 to present RHC encounter rates, July 1, 2022 to September 30, 2022 RHC encounter rates, April 1, 2022 to June 30, 2022 RHC encounter rates, October 1, 2022 to present RHCenhancement rates, July 1, 2022 to September 30, 2022 RHC enhancement rates, April 1, 2022 to June 30, 2022 RHC enhancement rates, October1, 2022 to present SBHS billing guide, July 1, 2022 to September 30, 2022 SBHS billing guide, October 1, 2021 to June 30, 2022 SBHS billing guide, July 1, 2022 to present SBHS fee schedule, October 1, 2021 to June 30, 2022 SBHS fee schedule, July 1, 2021 to September 30, 2021 SBHS fee schedule, July 1, 2022 to present Sleep centers billing guide, October 1, 2020 to June 30, 2022 Sleep centers billing guide, January 1, 2020 to September 30, 2020 Sleep centers billing guide, July 1, 2022 to present Sleep centers fee schedule, July 1, 2021 to June 30, 202 Sleep centers fee schedule, July 1, 2020 to June 30, 2021 Sleep centers fee schedule, October 1, 2022 to Present Sterilization billing guide, July 1, 2022 to September 30, 2022 Sterilization supplemental billing guide, October 1, 2021 to June 30, 2022 Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687) English large print, Sterilization Consent Form (HHS-687-1) (Spanish), Sterilization Consent Form (HHS-687-1) Spanish large print, October 1, 2022 to present Substance use disorder billing guide, July 1, 2022 to September 30, 2022 Substance use disorder billing guide, April 1, 2021 to June 30, 2022 Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, July 1, 2022 to present Substance use disorder fee schedule, October 1, 2021 to June 30, 2022 Substance use disorder fee schedule, January 1, 2021 to September 30, 2021 Substance use disorder fee schedule, View all substance use disorder fee schedules, November 2, 2022 to present - Apple Health (Medicaid) telemedicine policy and billing, August 1, 2022 to November 1, 2022 Apple Health (Medicaid) telemedicine policy and billing, August 1, 2022 to present Apple Health (Medicaid) physical health audio-only procedure codes, August 1, 2022 to present Apple Health (Medicaid) audio-only behavioral health codes, June 28, 2022 to July 31, 2022 Telehealth services billing guide audio only supplement, August 1, 2022 to present Apple Health (Medicaid) clinical policy and billing for COVID-19, July 22, 2022 to July 31, 2022 Apple Health (Medicaid) clinical policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) clinical policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) clinical policy and billing, View all clinical policy and billing FAQs, June 6, 2020 to December 31, 2021 Apple Health (Medicaid) telemedicine/telehealth brief, May 10, 2020 to June 6, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, April 29, 2020 to May 9, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, August 1, 2022 to present Apple Health (Medicaid) behavioral health policy and billing, February 1, 2022 to July 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, April 29, 2021 to January 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, View all behavioral health policy and billing FAQs, July 22, 2022 to present Apple Health (Medicaid) ABA policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) ABA policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) ABA policy and billing, July 22, 2022 to present Apple Health (Medicaid) FAQ for diabetes education providers, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, View all FAQs for diabetes education providers, May 3, 2020 to present Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, November 20, 2020 to May 2, 2021 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, October 1, 2020 to November 19, 2020 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, View all home health services billing and policy FAQs, July 22, 2022 to present Telehealth requirements for physical, occupational and speech therapy, February 1, 2022 to July 21, 2022 Telehealth requirements for physical, occupational and speech therapy, January 1, 2022 to January 31, 2022 Telehealth requirements for physical, occupational and speech therapy, View all telehealth requirements for physical, occupational, and speech therapy, January 1, 2022 to present Telehealth services in long term care facilities and skilled nursing facilities, May 3, 2021 to December 31, 2021 Telehealth services in long term care facilities and skilled nursing facilities, October 1, 2020 to May 2, 2021 Telehealth services in long term care facilities and skilled nursing facilities, View all Telehealth requirements for LTC and SNF, February 1, 2022 to present Family planning only billing guide telemedicine/telehealth, January 1, 2022 to January 31, 2022 Family planning only billing guide telemedicine/telehealth, May 3, 2021 to December 31, 2021 Family planning only billing guide telemedicine/telehealth, October 1, 2022 to present Tribal health billing guide, July 1, 2022 to September 30, 2022 Tribal health billing guide, January 1, 2022 to June 30, 2022 Tribal health billing guide, View all Tribal Health Program billing guides, January 1, 2022 to present Tribal health program fee schedule, October 1, 2021 to December 31, 2021 Tribal health program fee schedule, January 1, 2021 to September 30, 2021 Tribal health program fee schedule, July 1, 2022 to present Vision hardware billing guide, January 21, 2022 to June 30, 2022 Vision hardware billing guide, January 1, 2022 to January 20, 2022 Vision hardware billing guide, Guidance for hospitals in billing MCOs for services provided to newborns.pdf, (Fee-for-service benefits provided outside of the BHO process). Certain providers of Bill in a timely fashion. Provider Type 30 and 83 Personal Care Services - 8/15/20* Provider Type 32. For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. Contact; 855-609-9960 IVR Guide Fax Us Mail Us . You can decide how often to receive updates. Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment State policy The Medicaid Services Manual Provider Type 14 Billing Guide Updated: 12/23/2021 Provider Type 14 Billing Guide pv009/28/2021 2 / 21 Behavioral Health Outpatient Treatment authorized date, you may request review for continued service(s) prior to the last authorized date. 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. <> An official website of the United States government ) The UPIN must be present on inpatient Part A bills with a "Through" date of January 1, 1992, or later. Provider Type 32 Ambulance, Spec 249 Comm Paramed Provider Type 32 Ambulance, Spec 932 Ambulance Air or Ground Provider Type 33 Durable Medical Equipment, Prosthetics, Orthotics & Supplies; Provider Type 34 Therapy Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19), Provider billing guides and fee schedules, Use interactive voice response (IVR) to verify eligibility, Verifying eligibility using a magnetic card reader or MEV service, Casualty claims and health insurance claims, Instructions to fill out the General Information for Authorization Request form, Medicare crossover claim payment methodology, Direct Data Entry (DDE) webinar for billing dental claims, Direct Data Entry (DDE) webinar for billing professional claims, How to resubmit a paper claim using ProviderOne, Professional rates, fee schedules, and billing guides, Insurance company carrier codes (February 2022).xlsx. Physicians. Visit our Forms and publications page to download authorization forms. Critical Access Hospitals. How do providers identify the correct payer? See Physician-related/professional services.). &-@10mk_q These may specify that the buyer has a maximum number of days to pay and is sometimes offered a discount if paid . x]rFwa.-WUdQ$es$jI@)5@J$f5t"K$I~}l$g\gtFW,/&/zY2s1|)foxm9Za . Z+x. Anesthesiologists. 3]V8b{i 23NfnC~9SfqgV-y Provider Type 64 Billing Guide Updated 04/21/2021 Provider Type 64 Billing Guide pv 12/03/2019 1 / 4 Hospice The Hospice program is designed to provide support and comfort for Medicaid-eligible recipients who have a terminal illness and have decided to receive end of life care. How do I notify SEBB that my loved one has passed away? Add Acquisitions filter . 0 %PDF-1.5 % All Providers must ensure they are billing for services covered under their assigned specialty and category of service. If you are not receiving regular invoices via email, please contact our billing team to ensure that your contact and billing information is correct. Revised: 12/5/2011 Provider Type 14 Billing Guide 4 / 11 . Provider Type. Do you need a PA form? <>/Metadata 1700 0 R/ViewerPreferences 1701 0 R>> You will use these regularly as you submit your claims. Clinical Labs. Arizona Complete Health-Complete Care Plan has noticed a significant increase in provider claims denying for the servicing provider's Provider Type being invalid to bill for the procedure code (s).

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