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ICF-MR PROVIDER TRAINNG

ICF-MR PROVIDER TRAINNG. Sandhills Center LME/MCO. 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

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ICF-MR PROVIDER TRAINNG

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  1. ICF-MR PROVIDER TRAINNG Sandhills Center LME/MCO

  2. SHC Waiver Implementation Date 12/01/2012

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Other Resources • SHC Provider Helpdesk Phone: 1-855-777-4652Email:providerhelpdesk@sandhillscenter.org • SHC Websitewww.sandhillscenter.org For Provider>Finance/Claims EOB Crosswalk Rates UB04

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