county jail medical claims billing
DESCRIPTION
County Jail Medical Claims Billing. ND Department of Human Services Medical Services Division. October 8, 2012. Member Enrollment Form. Member Dis-Enrollment Form. $30 Per Claim Processed. $ Amount Paid For the Service (using ND Medicaid fee schedule). +. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/1.jpg)
ND Department of Human Services
Medical Services Division
County Jail Medical Claims Billing
October 8, 2012
![Page 2: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/2.jpg)
Member Enrollment FormND Department of Human Services, Medical Services Division 2
![Page 3: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/3.jpg)
Member Dis-Enrollment FormND Department of Human Services, Medical Services Division 3
![Page 4: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/4.jpg)
County Jail Medical Claims Billing Invoice
$30Per ClaimProcessed
$ Amount Paid
For the Service
(using ND Medicaid fee schedule)
+
ND Department of Human Services, Medical Services Division 4
![Page 5: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/5.jpg)
ND Department of Human Services, Medical Services Division 5
SAMPLE
![Page 6: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/6.jpg)
ND Department of Human Services, Medical Services Division 6
SAMPLE
![Page 7: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/7.jpg)
ND Department of Human Services, Medical Services Division 7
SAMPLE
Processing Fee
![Page 8: County Jail Medical Claims Billing](https://reader035.vdocuments.site/reader035/viewer/2022062315/5681609d550346895dcfc5bf/html5/thumbnails/8.jpg)
Direct Questions to: Maggie Anderson, 701-328-1603 or
via email at [email protected]
Forms Inquiries:Mary Lou Thompson, 701-328-2322 or
via email at [email protected]
Claims Inquiries: Provider Relations, 701-328-4043
ND Department of Human Services, Medical Services Division 8