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1. How to Use DDE Professional Billing
3. Go to www.medicaid.state.ar.us
Click on �Provider�
Click on �Log on�
Enter the provider�s 9-digit Medicaid ID number (PIN) as the User ID
The setup password is the provider�s SSN (will be prompted to change)
Click the Submit button
Log On
5. Header: Submitter Information
6. Entity Type
Enter person
Last/Organization Name/First Name
Enter the Provider last and first name
Electronic Transmitter ID
Enter eight zeroes: 00000000
Name/Telephone number
Enter your name and phone number, including area code
Submitter
7. Header: Billing Provider
8. Medicaid Provider ID/NPI
Enter the provider�s Medicaid ID number and leave the NPI field blank
Billing Provider
9. Header: Subscriber Information
10. Enter the beneficiary�s information
Last Name
First Name
Middle Name (not required)
Medicaid beneficiary ID number
Address, including City, State, Zip
Birth Date
Format is MMDDYYYY
If DOB is 01/01/2010, enter 01012010
Gender Subscriber
11. Header: Claim Information
12. Patient Account Number
12345
Place of Service
Place of service - Enter 12 Claim Information
13. Header: Diagnosis Codes
14. Principal Diagnosis Information
Enter the primary diagnosis code
Do not include the decimal
Example: If DX is 111.11, enter 11111
Other Diagnosis Information
Enter additional diagnosis codes if applicable Diagnosis Codes
15. Services: Add Service to Claim
16. Procedure
Enter S5125
Charge
The dollar amount that you are billing. Using the Pay Grid that follows, enter the Billing Amount for the hours you worked.
Quantity
Units of time that you worked. Using the Pay Grid that follows, enter the Units Worked for the hours you worked.
Diagnosis Code Pointer
Enter 1
Add Service to Claim
17. Pay Grid
18. Pay Grid
19. Services: Service Date/NDC Info
20. Service Date Period (first day worked)
Enter the From and To date of service � (1 day) � same date
Format is MMDDYYYY
If the date of service is 1/1/2010, enter 01012010
Click Add
Services: Service Date/NDC Info
21. Services: Adding the Service
22. Once you click the Add button, it will add your service to the top of the screen
Once you have added the service, you can add a second service, third service, etc.
Click Submit Adding Service (Additional Days) on Claim/Submit Claim