Claim Formats:
When possible, providers should submit claims electronically via a claims clearinghouse service to payer code NDMSA (HHS NATIONAL DISASTER MEDICAL SYSTEM-APPRIO). For all electronic claims received, an electronic remittance advice will be returned which will make payment reconciliation more efficient for the provider.
If needed or preferred, the program will continue to accept hard-copy claims as well. Hard-copy claims must be submitted to Apprio using industry standard pre-printed claim forms:
Secondary claims should be mailed to the program in hard-copy format along with a copy of the remittance advice or explanation of benefits document received from the primary payer.
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 Quick Guide:
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 Reimbursement Program is currently not activated and is not accepting any claims.
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.
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 appeals to:
Apprio at 425 3rd Street, SW, Suite 600, Washington, DC 20024 or fax them to: 202.892.7200.
Appeals Submission Deadline:
The deadline for filing an appeal is 45 days after receipt of the Explanation of Benefits from NDMS.
