Sandhills Center LME/MCO ICF-MR PROVIDER TRAINNG

SHC Waiver Implementation Date

12/01/2012

Submission of Claims

Provider can submit claims to:

> Rubicon

• Contract in place with Rubicon • Serves as Member Company agent for providers with a contract • Addresses claims, billing, or payment issues between Member Company and Sandhills

Submission of Claims-Cont.

>Sandhills

HIPAA standard EDI Transaction Files 837 Professional Health Care Claim 837 Institutional Health Care Claim Companion Guides are located on the SHC Website www.sandhillscenter.org

For Provider>Finance/Claims

Submission of Claims-Cont.

>

Sandhills Direct Data Entry Web Tool User Guide is located on the SHC Website www.sandhillscenter.org

For Providers>Finance/Claims >Paper Claim

Sandhills Direct Data Entry Password

• To request your DDE Web Tool login and password: Please fill out the SHC DDE request form located on our website: www.sandhillscenter.org

Click on For Providers >Finance/Claims

Paid Claims and Denials

Remittance Advice will be available via:

• Electronic 835 – Share File • Paper Providers may also view claims on line

Payments/Checks will be available via:

• Electronic Fund Transfer (EFT) – To sign up, complete EFT form on SHC website: www.sandhillscenter.org

For Providers>Finance/Claims • Paper

Keeping Current

It is the responsibility of the provider to research and stay abreast of new requirements and laws by utilizing all • • available resources:

Monthly Medicaid Bulletins DMA and DMH Implementation Updates

• www.ncdhhs.gov/dma/ • •

SHC Communications/Bulletins SHC Website

www.sandhillscenter.org

Other Resources

• SHC Provider Helpdesk Phone: 1-855-777-4652 Email:[email protected]

• SHC Website www.sandhillscenter.org

For Provider>Finance/Claims EOB Crosswalk Rates UB04