Introduction
Find instructional guides and forms for all your levels of care and administrative needs by selecting ‘Guides’ and ‘Forms’ in the menu.
Guides
Authorization Parameters
Authorization Spans and Codes
Billing Appendix
Claims Denial Mitigation Project
Master Service Authorization Grids (MSAG)
EVS User Guide
837 Companion Guides
ProviderConnect User Guide
Levels of Care Appendix
UB04 Billing Instructions
Long Term Care – OES Process & Spans Reporting
DORS User Guide
Forms
1915(i) Referral Form
Claims Appeals Form
Bed Hold Form
Release of Information (ROI) and Referral Forms
Third-Party Liability Forms
LBHA Exception Form for the Uninsured
CMS 1500 Form
OES Forms
DHR/IMA 81 Form
Provider Account Request Forms
Provider Claims Appeals Request Form