How to use DDE
Professional Billing
How to use DDE:
Professional Billing
Log on
• Go to www.medicaid.state.ar.us
• 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
How to use DDE:
Professional Billing
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
Header: Submitter Information
How to use DDE:
Professional Billing
Submitter
• Entity Type
– 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 88888888
• Name/Telephone number
– Enter name and phone number of the person who is billing
How to use DDE:
Professional Billing
Header: Billing Provider
How to use DDE:
Professional Billing
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
Header: Subscriber Information
How to use DDE:
Professional Billing
Subscriber
• Enter the recipient’s information
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–
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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 01012010
– Gender
How to use DDE:
Professional Billing
Header: Claim Information
How to use DDE:
Professional Billing
Claim Information
• Patient Account Number
– 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
Header: Admission and File Info
How to use DDE:
Professional Billing
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
Header: PA/EPSDT Referral
How to use DDE:
Professional Billing
PA/EPSDT Referral
• Prior Authorization Number
– 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
Header: Diagnosis Codes
How to use DDE:
Professional Billing
Diagnosis Codes
• 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
Header: Referring/Service
Facility
How to use DDE:
Professional Billing
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
COB: Other Subscriber
How to use DDE:
Professional Billing
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
COB: Other Subscriber Cont.
How to use DDE:
Professional Billing
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 01012010
• Gender
How to use DDE:
Professional Billing
COB: Other Payer
How to use DDE:
Professional Billing
Other Payer
• Organization Name
– 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
Other Payer Cont.
• Adjustments for Medicare Insurance
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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
COB Once Added to Claim
How to use DDE:
Professional Billing
Services: Add Service to Claim
How to use DDE:
Professional Billing
Add Service to Claim
• Procedure
– 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
Services: Service Date/NDC Info
How to use DDE:
Professional Billing
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
Services: Rendering Provider
How to use DDE:
Professional Billing
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
Services: NET Provider
How to use DDE:
Professional Billing
NET Provider
• Required only for NET providers
• Indicate yes or no
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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
Services: Adding the Service
How to use DDE:
Professional Billing
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