Backdating medicare forms

For additional information, please refer to the Pharmacy Services website at DHS.us/provider/pharmacyservices/index.htm, If you submit paper claim forms, please verify that the mailing address is correct.Response: The Provider Claim Inquiry window in the PROMISe™ Provider Portal is used to search claims, view original claims by ICN, and check the status of one or more claims.

The department must receive the provider’s 180-day exception request within 60 days of the date indicated on the third party denial or approval.

The MA 307 must be submitted with the corresponding batches of individual provider’s claims (maximum of 100 invoices per transmittal).

Response: Providers must obtain applicable recipient signatures either on the claim form or must retain the recipient’s signature on file using the Encounter Form (MA 91).

When the MA-307 is used, claims must be separated and batched according to the individual provider who rendered the services.

Individual provider numbers must be provided in the spaces provided on the MA 307.

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