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ND Department of Human Services Medical Services Division County Jail Medical Claims Billing October 8, 2012

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County Jail Medical Claims Billing. ND Department of Human Services Medical Services Division. October 8, 2012. Member Enrollment Form. Member Dis-Enrollment Form. $30 Per Claim Processed. $ Amount Paid For the Service (using ND Medicaid fee schedule). +. - PowerPoint PPT Presentation

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Page 1: County Jail Medical Claims Billing

ND Department of Human Services

Medical Services Division

County Jail Medical Claims Billing

October 8, 2012

Page 2: County Jail Medical Claims Billing

Member Enrollment FormND Department of Human Services, Medical Services Division 2

Page 3: County Jail Medical Claims Billing

Member Dis-Enrollment FormND Department of Human Services, Medical Services Division 3

Page 4: County Jail Medical Claims Billing

County Jail Medical Claims Billing Invoice

$30Per ClaimProcessed

$ Amount Paid

For the Service

(using ND Medicaid fee schedule)

+

ND Department of Human Services, Medical Services Division 4

Page 5: County Jail Medical Claims Billing

ND Department of Human Services, Medical Services Division 5

SAMPLE

Page 6: County Jail Medical Claims Billing

ND Department of Human Services, Medical Services Division 6

SAMPLE

Page 7: County Jail Medical Claims Billing

ND Department of Human Services, Medical Services Division 7

SAMPLE

Processing Fee

Page 8: County Jail Medical Claims Billing

Direct Questions to: Maggie Anderson, 701-328-1603 or

via email at [email protected]

Forms Inquiries:Mary Lou Thompson, 701-328-2322 or

via email at [email protected]

Claims Inquiries: Provider Relations, 701-328-4043

ND Department of Human Services, Medical Services Division 8

mailto:[email protected]
mailto:[email protected]

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