Standard Reimbursement to Providers:
Providers are reimbursed the lesser of Medicaid or Medicare or Billed Charges in accordance with Title 18, Part 3, Chapter 301, Section 4006 of US Code for authorized services. (See http://www4.law.cornell.edu/uscode/18/4006.html)
All services require an authorization from the Division of Immigration Health Services (DIHS).
- Treatment Authorization Requests (TARs) are submitted directly from the custodial facility to DIHS.
- DIHS returns the TAR to the custodial facility and denotes the
A copy of the TAR should be provided to you by the custodial facility.
services is subject
services the TAR is
valid for 30 days
after the date of
issue and cannot be
used for health
prior to the date of
services the TAR is
valid for 7 days
prior to the TAR
date of issue.
All health services
are subject to
If you have questions regarding what services are authorized, please contact the referring custodial facility or contact the appropriate DIHS' Managed Care Coordinator (MCC) (LINK to MCC STATE Lookup page here) and provide him/her with the Authorization Number.
Only authorized services will be reimbursed.
- All Ancillary Provider claims must be submitted on either a CMS 1500 or, for health facilities a HCFA 1450 in order to be processed*.
- All Ancillary Provider claims must have the appropriate CMS 1500 fields completed or, for health facilities appropriate HCFA 1450 fields completed*. HCFA 1450 required fields HCFA 1500 requried fields
- Claims should be mailed to:
Division of Immigration Health Services
1220 L St. NW
Washington, DC 20005
*Failure to submit a claim using the appropriate claim form and completing the required fields will result in a denied claim.
Please call 1-800-479-0523
- Questions regarding claim status, please call 1-800-479-0523
- Questions regarding reimbursement policy or claims submission process please email
- Questions regarding authorized services should be directed to the appropriate MCC.