What you need to know about billing to Medicaid
Beverly Remm
Director of Billing
Orion Healthcare Technology

Medicaid Provider Enrollment
o National Provider Identifier
 Obtaining an National Provider Identifier Number
 What is an NPI?
o Medicaid Enrollment Process

Options for Billing to Medicaid
o Using a State System
o Outsource Billing Service
o Billing Software
Preparing to Bill to Medicaid | May 4, 2011
Preparing to Bill to Medicaid | May 4, 2011
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If you provide services to patients who are Medicaid
eligible or already have Medicaid coverage.
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If you would like to start providing services to
Medicaid eligible clients and receive
reimbursements from Medicaid for those services.
Preparing to Bill to Medicaid | May 4, 2011
Preparing to Bill to Medicaid | May 4, 2011
Preparing to Bill to Medicaid | May 4, 2011

Mandated by the Health Insurance Portability and
Accountability Act of 1996 (HIPAA)

Issued by Center for Medicaid and Medicare (CMS)

A Unique 10 digit Identifier for healthcare providers
(facilities and individuals)
Preparing to Bill to Medicaid | May 4, 2011

Licensed individuals and entities that provide health
care services

Providers that are going to bill for health care services

Any health care provider that has a taxpayer identifying
number.
Who should not apply for an NPI Number
 Groups, partnerships, or corporations.
 Physicians who have opted out of government medical
programs.
Preparing to Bill to Medicaid | May 4, 2011

Website: https://nppes.cms.hhs.gov/NPPES/
- Online application or download forms
- Have your application information ready

Receive your NPI number typically in 1-2 weeks

Call NPPES at 1-800-465-3203 for assistance
Preparing to Bill to Medicaid | May 4, 2011
Every State Medicaid program will have different
requirements and processes for Provider Enrollment.

Application forms

Copies of documentation (example: W-9, license
certification, etc.)

Signed Provider Agreements
Preparing to Bill to Medicaid | May 4, 2011

Many state Medicaid programs will have documents
and instructions online.
◦ Listing requirements
◦ Steps for enrolling

Billing services can assist with process
◦ Completing forms
◦ Gathering the required documents
◦ Follow up on application status
Preparing to Bill to Medicaid | May 4, 2011
Once you have become a Medicaid provider your next
step is to become familiar with Medicaid guidelines
and billing requirements.
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Billable and Payable Service Codes
Current Fee Schedules
Medicaid Billing guidelines
Timely Filing Limitations
Preparing to Bill to Medicaid | May 4, 2011
Based on your provider enrollment contract there
are some standard questions that you should ask
your State Medicaid contact:

How can I verify client eligibility?

Do I need authorizations for services rendered?

What are Medicaid’s Claims Submission guidelines
and options?
Preparing to Bill to Medicaid | May 4, 2011
Preparing to Bill to Medicaid | May 4, 2011

Medicaid State Software Programs
◦ A software system offered by your State Medicaid to submit
provider billing and claim information

Outsource Services
◦ A contracted service to track and submit your billing and
claims for Medicaid, insurance, etc.

Billing Software System
◦ A software application used to track and submit your billing
and claims for Medicaid, insurance, etc.
Preparing to Bill to Medicaid | May 4, 2011
Pros
• Free software
• Enter specific
information needed
by Medicaid
Cons
• Limited information
output
• Duplication of data entry
• Extra time spent on
support needs
Preparing to Bill to Medicaid | May 4, 2011
What you should expect from your Billing Service
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Manage submission of all services to Medicaid
Knowledgeable with State and Medicaid guidelines
Assist with follow up on denied or unpaid claims
Clear understanding of your agency’s goals and needs
Provide detailed reports for services and claims
Work with insurance companies on claims issues to ensure
payment on claims
Preparing to Bill to Medicaid | May 4, 2011
What to look for in a Billing Software System
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HIPAA ready
Patient Privacy
Regular updates to software for industry compliance
Personal and reliable customer support
Easy to use
Electronic Claims Submission
Experience in your specialty and services
Preparing to Bill to Medicaid | May 4, 2011
Before you can Bill to Medicaid:
Obtain an NPI number
 Enroll as a provider with Medicaid
 Become familiar with Medicaid provider
guidelines

Preparing to Bill to Medicaid | May 4, 2011
When you are ready to bill for Medicaid:


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Take time to establish or review your organizations billing
policy and procedures
Choose the best method of submitting claims to Medicaid to fit
your needs.
 Using the state’s system
 Outsource Billing Service
 In House Billing Software
Implement and monitor your new billing program or service
Use available resources or experienced services to assist you
Preparing to Bill to Medicaid | May 4, 2011
Please contact Orion Healthcare Technology
today if you have any questions.
Call Us: 1-800-324-7966
Visit: www.MyAccuCare.com/billing
1016 Leavenworth Street
Omaha, NE 68102
phone: 402.341.8880
fax: 402.341.8911
www.myaccucare.com • info@orionhealthcare.com
Emily Haverty: ehaverty@orionhealthcare.com
1001 N. Fairfax Street., Ste. 201
Alexandria, VA 22314
phone: 703.741.7686/800.548.0497
fax: 703.741.7698/800.377.1136
www.naadac.org • naadac@naadac.org
Chris Campbell: chris@naadac.org
Preparing to Bill to Medicaid | May 4, 2011