NDMS | Claims Submission Quick Guide

Claims Submission Quick Guide

Before you start the claims process REMEMBER:

Verify benefits first! If the patient has Medicare, Tricare or VA benefits. If so...

The patients' care should be billed through their Medicare, Tricare, or VA benefits.
Please DO NOT file a claim through the NDMS Definitive Care Reimbursement Program.

HOWEVER, if the patient has...

Coverage	Billing Action
Private Health Insurance or non-Federal Public Coverage other than Medicaid	Other insurance billed as primary payer. NDMS billed as secondary payer for any unreimbursed amounts not to exceed 110% of Medicare rate for Hospitals with MOA or 100% of Medicare rate for Practitioners.
Medicare	NDMS billed as primary payer.
Dual Eligible (Medicare and Medicaid)	Medicare is the primary payer. Medicaid is the Secondary payer. Facility will submit EOB to NDMS in order to receive the 10% Admin fee. NDMS payer of last resort.

Benefit examples listed above are claim eligible! Use the Claims Submission.

Claims Submission Checklist

Ensure the NDMS Definitive Care Reimbursement Program has been activated.

Ensure the claim will fall under coverage guidelines.

Complete the Provider Registration forms, which includes:

W-9 Form
ACH Vendor Enrollment Form (Only fill in company and banking info)
NDMS Definitive Care Reimbursement Program Provider Enrollment Form

Complete the applicable claim forms:

Hospitals (CMS-1450)
Practitioners (CMS-1500)

Submit the claim and all Provider Registration Forms BEFORE the submission deadline by either.

Electronically via a claims clearinghouse service to payer code: NDMSA (HHS NATIONAL DISASTERMEDICAL SYSTEM-APPRIO)
Secure Encrypted Email: NDMS.reimbursement@apprioinc.com
Fax: 1-202-892-7200
Mail:
c/o Apprio
425 3rd Street, SW, Suite 600
Washington, DC 20024

For more information, please visit the NDMS Definitive Care Reimbursement Program. There you will find coverage guidelines, downloadable forms in PDF format and answers to FAQs!