Billing and Claims

Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). The QRGs include targeted claims and authorization instructions per provider type. The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics.

• Ancillary MMA/SMI/CW Including Home Health, PDN (PDF)
• Ancillary CMS Including Home Health, PDN (PDF)
• Ancillary LTC Including Home Health, PDN (PDF)
• Assisted Living Facility – LTC (PDF)
• Assisted Living Facility – MMA/SMI/CW (PDF)
• Behavioral Health and ABA (PDF)
• Durable Medical Equipment (PDF)
• Early Intervention Services Providers (PDF)
• General Information (PDF)
• Hospice (PDF)
• Hospitals (PDF)
• Licensed Midwife (PDF)
• MFC – Medical Foster Care (PDF)
• Nursing Facilities – LTC (PDF)
• Nursing Facilities – MMA/SMI/CW (PDF)
• Pediatric Nursing Facilities – CMS (PDF)
• Pediatric Primary Care Providers (PDF)
• Pediatric Therapy (PDF)
• PIC:TFK – Partners in Care Together for Kids (PDF)
• PPEC – Prescribed Pediatric Extended Care (PDF)
• Primary Care Providers (PDF)
• Specialists (PDF)
• Targeted Case Management (PDF)
• Therapy (PDF)
• Transportation (PDF)

Provider Billing Manual for Medicaid, Comprehensive Long Term Care and Child Welfare Specialty Plan (PDF)