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U.S. Department of Health and Human Services

Claims Submission

Claim Formats:

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


Claims Submission Deadline:

The NDMS Definitive Care Reimbursement Program is currently accepting claims for Hurricanes Irma and Maria.  The tentative deadlines for submission of primary and secondary claims to NDMS is January 15, 2018​.


Copies of Medical Records for Inpatients:

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.


Appeals:

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.

Mail hard copy claims to Apprio at 425 3rd Street, SW, Suite 600, Washington, DC 20024


Appeals Submission Deadline:

The tentative deadline for submission of primary and secondary claims to NDMS is January 15, 2018.  The deadline for filing an appeal is 45 days after receipt of the Explanation of Benefits from NDMS.​


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  • This page last reviewed: October 02, 2017