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Hospitals/Inpatient Providers

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

Authorized Services:

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 authorized services.
  • A copy of the TAR should be provided to you by the custodial facility.
  • Payment for authorized health services is subject to custody verification.
  • For all non-emergency authorized health services the TAR is valid for 30 days after the date of issue and cannot be used for health services rendered prior to the date of issue.
  • For emergency authorized health services the TAR is valid for 7 days prior to the TAR date of issue.
  • All health services are subject to retrospective review.

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.

Claims Submission:

  • All Hospital/Inpatient Provider claims must be submitted on a HCFA 1450 in order to be processed*.
  • All Hospital/Inpatient Provider claims must have the appropriate HCFA 1450 fields completed*. HCFA 1450 required fields.
  • Claims should be mailed to:
    Division of Immigration Health Services
    1220 L St. NW
    PMB 468
    Washington, DC 20005

*Failure to submit a claim using the appropriate claim form and completing the required fields will result in a denied claim.

Claims Inquiries:

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 [email protected]. Questions regarding authorized services should be directed to the appropriate MCC.


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