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Physician 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:
http://www4.law.cornell.edu/uscode/18/4006.htm)
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.
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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) and provide him/her with the Authorization Number.
Only authorized services will be reimbursed.
Claims Submission:
- All Physician Provider claims must be submitted on a HCFA 1500 in order to be processed*.
- All Hospital/Inpatient Provider claims must have the appropriate HCFA 1500 fields completed*. HCFA 1500 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:
- Questions regarding claim status, please call 1-800-479-0523
- Questions regarding reimbursement policy or claims submission process please email
providerinfo@dhs.gov.
- Questions regarding authorized services should be directed to the appropriate MCC.
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