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U.S. Department of Health and Human Services

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...

CoverageBilling 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:

  • Secure Encrypted Email:

  • 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!

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  • This page last reviewed: March 17, 2021