Billing Instructions
Please click on the links below to access the detailed
billing instructions for each of the individual billing forms:
| Paper and Electronic Billing and Remittance Advice Instructions |
Word |
PDF |
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| Paper Billing Instructions: |
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(.doc) |
(.pdf) |
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(.doc) |
(.pdf) |
- UB-92 - UB-92 Nursing Facilities, including instructions for billing Medicare Co-Insurance/Deductible
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(.doc) |
(.pdf) |
- Generic - HCFA 1500 (Old Form) Instructions
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(.doc) |
(.pdf) |
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(.doc) |
(.pdf) |
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(.TIF) |
- HCFA/CMS-1500 Home and Community Benefits for Mental Retardation, Section 21 including BMR Waiver
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(.doc) |
(.pdf) |
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(.doc) |
(.pdf) |
- Managed Mental Health Care Special Billing Instructions
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- Section 13 Case Management Services (Targeted)
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(.doc) |
(.pdf) |
- Section 17 Community Support Services
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(.doc) |
(.pdf) |
- Section 58 Licensed Clinical Social Worker, Licensed Clinical Professional Counselor and Licensed Marriage and Family Therapist Services
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(.doc) |
(.pdf) |
- Section 65 Mental Health Services
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(.doc) |
(.pdf) |
- Section 97 Private Non-Medical Institution Services
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(.doc) |
(.pdf) |
- Section 100 Psychological Services
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(.doc) |
(.pdf) |
- Section 111 Substance Abuse Treatment Services
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(.doc) |
(.pdf) |
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(.pdf) |
- Federally Qualified Health Centers
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(.pdf) |
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| Electronic Billing Instructions: |
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| Remittance advices: |
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- What Is A Remittance Advice (RA?
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(.doc) |
(.pdf) |
Note:If you can not read the above files you can use these links to
access Word
Viewer for .doc files or Adobe
Acrobat for .pdf files.
