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Reimbursement and Claims
Assistance:
Contact a Claims and Reimbursement Specialist through billingquestions@westernhighlands.org or phone (828) 225-2785 or 1-800-671-6560.NPI Information:
Obtain an NPI: https://nppes.cms.hhs.gov/NPPES/Welcome.do
Workgroup for Electronic Data Interchange (WEDI): http://www.wedi.org/
Taxonomy : http://www.wpc-edi.com/taxonomy
Medicaid NPI Registration: http://www.dhhs.state.nc.us/dma/
Western Highlands NPI Registration Instructions:
See Western Highlands
Communication Bulletin #54
| Fee Schedules | ||
| WH Fee Schedule (06/30/08) | Excel Spreadsheet | |
| DMA Fee Schedule: http://www.dhhs.state.nc.us/dma/fee/fee.htm | ||
| Instructional Aides | ||
| WH Explanation of Benefits/Code Description | Excel | |
| Western Highlands Fee Collection Policy (09/27/07) | Word File | |
Instructions for Completing CMS1500 (02/16/07) |
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| DMA Memorandum Re:
Rounding ( |
Word File | |
NC DMA HIPAA Code
Conversion |
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| Forms | ||
| CMS-1500 (formerly HFCA-1500) Health Insurance Claim
Form. Re-posted 02/16/07. NOTE: this is a special PDF file that contains form fields you can fill in on screen, then print, save, or fax it. You MUST save this file to your own computer before using it, DO NOT fill it in online! This is not a secure website. If you fill it out online you will violate HIPAA privacy/security laws. |
PDF (457 Kb) | |
| Claims Resolution Inquiry | Word File | |
Direct Data Entry
User Application |
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| Residential Service Invoice (01/01/04) | Word File | |
| Provider Service Note (01/01/04) | Word File | |
| Private Provider Service Note (01/01/04) | Word File | |
| Child Residential Service Note (01/01/04) | Word File | |
| Day Treatment Weekly Service Note (01/01/04) | Word File | |
| State Funding Eligibility Statement 01/25/08 | Word File | |
| Medicaid Direct Enrolled Provider Billing Registration Application (04/02/08) | Word File | |
| Communication Bulletins | ||
| Bulletin #83 - 06/26/2008 Provisionally Licensed and Non-Licensed Substance Abuse Counseling Professionals |
Word File | |
| Bulletin #76 - 02/11/08 National Provider Identification (NPI) Implementation Transition Assistance |
Word File | |
| Bulletin #67 - 10/15/07 Claim Submission Requirements |
Word File | |
| Bulletin #60 - 04/24/07 National Provider Identifier (NPI) Deadline Lifted |
Word File | |
Bulletin #57 - 03/27/07 Notice: Not having a properly registered NPI with Medicaid and/or Western Highlands may result in non-payment for services. |
Word File | |
| Bulletin #55 - 03/05/07 Western Highlands Network IPRS Timely Filing Limits |
Word File | |
| Bulletin #54 - 02/19/07 National Provider Identifier (NPI) What is NPI, How to Register, and How to Bill |
Word File | |
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Excel Spreadsheet | |
| Bulletin #52 - 01/10/07 Children’s Residential Treatment Level II Group (H2020) Children Residential Treatment Level III and IV (H0019) Medicaid Reimbursement |
Word File | |
| Bulletin #51 - 01/02/07 Standardized Children in Residential Placement Room and Board Authorization/Reimbursement |
Word File | |
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Word File | |
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| Bulletin #50 - 12/08/06 Lifting of 60-day Timely Filing Edit |
Word File | |
| Bulletin #49 - 12/05/06 Electronic Claims Submission Effective July 1, 2007 |
Word File | |
| Bulletin #48 - 11/07/06 Request to Change Contract Maximum |
Word File | |
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Word File | |
| Bulletin #47 - 08/17/06 Western Highlands Network IPRS Timely Filing Limits |
Word File | |
| Bulletin #46 - 07/20/06 Guidelines for Medical/Psychiatric Consultation |
Word File | |
| Bulletin #38 - 06/06/06 Clarification of Service Authorizations for Individuals with Out of County Medicaid (see also: Service Authorization page) |
Word File | |
| Bulletin #37 - 06/02/06 Room and Board Reimbursement Rates for Child Mental Health Residential Providers |
Word File | |
| Bulletin #36 - 06/02/06 Purchase of Services Agreements (Contracts) for IPRS Funded Services for Fiscal Year 2007 |
Word File | |
| Bulletin #35 - 05/05/06 CAP-MR/DD Waiver Equipment and Supply Reimbursement Effective July 1, 2006 |
Word File | |
CAP-MR/DD Supply/Equipment Receipt and Authorization Confirmation Form |
Word File | |
| Bulletin #34 - 04/25/06 Level III and IV Residential Rates |
Word File | |
| Bulletin #30 - 03/30/06 Enhanced Benefits Reimbursement |
Word File | |
| Bulletin #23 - 02/27/06 Claim Submission Requirements for State Funded Services |
Word File | |
Deadlines for Submitting Claims for IPRS Reimbursement |
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| Bulletin #22 - 02/22/06 Therapeutic Leave for ADMRI Residential Services |
Word File | |
| Bulletin #21 - 12/29/05 CPT 2006 Code Review |
Word File | |
Bulletin #21 Addendum (01/17/2006) |
Word File | |
| Bulletin #20 -12/28/05 Authorization and Reimbursement for CMSED Residential Treatment Room and Board. Related Documents: |
Word File | |
Co-pay Letter to Parents |
Word
File Word File Word File |
PDF |
| Bulletin #17 - 11/01/05 Authorization & Reimbursement for Residential Treatment Room & Board |
Word File | |
| Bulletin #16 - 09/30/05 DD Targeted Case Management Billing |
Word File | |
| Bulletin #15 - 09/30/05 Recoupment, Reimbursement, Direct Enrollment Updates |
Word File | |
| Bulletin #14 - 09/21/05 Rate Adjustments and Benefit Design Changes Respite and Room & Board |
Word File | |
| Bulletin #13 - 07/21/05 Consumers With Private Insurance: A Clarification of the Coordination of Benefits Policy of 01/13/05 |
Word File | |
| Bulletin #12 - Updated 04/02/08 Reimbursement Business Practice Modifications and Medicaid Direct Enrolled Provider Registration |
Word File | |
| Bulletin #11 - 06/02/05 Western Highlands Payment Cycles - FY 2006 |
Word File | |
| Bulletin #10 - 05/05/05 Western Highlands Claims/Authorization Table |
Excel Spreadsheet | |
| Bulletin #9 - 01/14/05 Coordination of Benefits Policy |
Word File | |
| Bulletin #8 - 01/14/05 Issues Related to Claims and Reimbursement |
Word File | |
| Bulletin #7 - 01/12/05 Updates on important issues |
Word File | |
| Bulletin #6 - 12/10/04 Updates on important issues |
Word File | |
| Bulletin #4 - 11/17/04 Re: Language Translation and Interpretation |
Word File | |
| Bulletin #2 - 10/14/04 Clarifications |
Word File | |
| Bulletin #1 - 09/23/04 Clarifications |
Word File | |