Public Health Emergency - Leading a Nation Prepared
Given the relatively infrequent occurrence of public health emergencies requiring NDMS Definitive Care, all claims must be submitted to Apprio in hard-copy format using pre-printed claim forms:
The National Provider Identifier (NPI) will be required. All claims will be reviewed for compliance with the National Correct Coding Initiative (NCCI) edits as required by the Centers for Medicare & Medicaid Services (CMS).
Mail hard copy claims to Apprio at 425 3rd Street, SW, Suite 600, Washington, DC 20024
The NDMS Definitive Care Reimbursement Program has compiled a NDMS Claims Submission Quick Guide to assist claimants with the submission process. The guide provides benefit examples that are claim eligible and a claim submission checklist to follow when submitting a claim.
Claims Submission Deadline: The NDMS Definitive Care Reimbursement Program is currently accepting claims for Hurricane Maria. The tentative deadlines for submission of primary and secondary claims to NDMS is January 15, 2019 for U.S. Virgin Islands patients and December 28, 2018 for Puerto Rico patients.
Please note that the NDMS may require copies of medical records for all patients who are admitted as inpatients by facilities in order to support their follow up utilization and efficacy studies. Please be sure to complete the section on Medical Records Copying in the Provider Registration form.
In the event that a provider would like to appeal a claim adjudication decision or payment amount, the following form should be completed and submitted with all supporting documentation within 45 days of receipt of a remittance advice or claim denial notice from the program.
The tentative deadline for submission of primary and secondary claims to NDMS is September 30, 2018. The deadline for filing an appeal is 45 days after receipt of the Explanation of Benefits from NDMS.
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