Providers must submit claims for services provided in order to be reimbursed. In order for a provider to be able to submit claims;
- The provider must be certified to provide the service
- The services are identified in an approved individual service plan (ISP) and the PAWS (payment authorization for waiver services) has been processed
- The service has been provided and documented; and the claim is being submitted within 350 days of the service being provided
Each service is associated with its own billing codes and rate of payment, which can be found in the appendix to the service rule. It is the provider’s responsibility to ensure the accuracy of their billing. If you are not comfortable or able to submit your own claims, you can associate with a billing agent to submit claims on your behalf.
There are two methods to bill: single claim entry through eMBS or Monthly Rate Calculator (MRC) through MSS.
Independent providers will only bill through eMBS. Agency providers may use either eMBS or MRC depending on the service being claimed.
Billing agent information as well as additional information regarding claims and billing can be found through DODD.
- Using eMBS to bill claims and view reports
- Viewing the PAWS
- How to Back out Previously Billed Claims
- How to Report Patient Liability
Invoices submitted for payment or billing are not considered documentation. You must maintain your documentation for a minimum of 6 years or until an initiated audit is completed, whichever is longer.