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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
     
     
Paper Billing Instructions:    
  • UB-04  
(.doc) (.pdf)
  • Generic - UB-92
(.doc) (.pdf)
  • UB-92 - UB-92 Nursing Facilities, including instructions for billing Medicare Co-Insurance/Deductible
(.doc) (.pdf)
  • Generic - HCFA 1500 (Old Form) Instructions
(.doc) (.pdf)
  • CMS 1500 New Form
(.doc) (.pdf)
  • CMS 1500 New Form Sample
(.TIF)
  • HCFA/CMS-1500 Home and Community Benefits for Mental Retardation, Section 21 including BMR Waiver
(.doc) (.pdf)
  • Dental
(.doc) (.pdf)
  • Managed Mental Health Care Special Billing Instructions
   
    • Section 13 Case Management Services (Targeted)
(.doc) (.pdf)
    • Section 17 Community Support Services
(.doc) (.pdf)
    • Section 65 Mental Health Services
(.doc) (.pdf)
      • Crosswalk of New Codes Effective August 1, 2008 to Previous Codes
(.doc) (.pdf)
    • Section 97 Private Non-Medical Institution Services
(.doc) (.pdf)
  • Rural Health Centers
  (.pdf)
  • Federally Qualified Health Centers
  (.pdf)
     
2009 ICD9 Diagnosis and Procedure (Surgical) Codes List:    
  • New, Changed or Deleted 2009 ICD9 Diagnosis and Procedure (Surgical) Codes
(.doc) (.pdf)
     
Void and Adjustment Instructions:    
  • Void Instructions
(.doc) (.pdf)
  • Adjustments Instructions
(.doc) (.pdf)
     
Electronic Billing Instructions:    
   
     
Remittance advices:    
  • What Is A Remittance Advice (RA)?
(.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.