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Hospitals Information - Billing Tips

Hospitals Billing Tips

  1. Verifying Eligibility – Verify recipient eligibility for Medicaid benefits and services at the beginning of each month or at each visit.  Recipients may be enrolled in programs with restricted services.  Certain services require prior approval for reimbursement. Please refer to the fee schedule to confirm if a PA is required.  This information may be obtained from the Interactive Voice Response (IVR) system by calling (202) 906-8319 (in District) or (866) 752-9231(outside DC metro area).

     

    The IVR will prompt you to enter your provider number. This is the nine-digit number assigned to you through the Medicaid program. The system will then prompt you to enter the recipient number. This eight digit code is listed on the patient’s Medical Assistance Card. 

  2. Retroactive Eligibility – When a recipient receives retroactive eligibility, include an attachment indicating the recipient's retroactive eligibility.

     

  3. Medicare Denials – When billing for services denied by Medicare for recipients who are eligible for Medicare and Medicaid, you must attach the EOMB statement of Medicare denial to the claim.

     

    TPL Denials - When the third party payment source denies payment, you must attach the EOB statement of denial to the claim.