Billing Instructions

Billing Instructions Table of Contents

Ted Strickland, Governor

Douglas E. Lumpkin, Director

Ohio Department of Job and Family Services

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eManual Contents
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Medical Assistance Letters	Introduction	Paper Claim Form and Other Claim Format GRID	BIN.1000. Billing Claim Forms and Prior Authorization
BIN.1001. CMS 1500 Revised Versions for 1990 and 2005	BIN.1003. JFS 03142 Prior Authorization	BIN.1004. JFS 03612 Dental Prior Authorization	BIN.1005. JFS 03452 Practitioner Certification For Medical Transportation Services
BIN.1006. ADA Version 2000, Dental Billing Form	BIN.1007. Instructions for the UB-92, Independent Free-Standing Dialysis Clinic	BIN.1100. JFS 06780, For Medicare Crossover	BIN.1101. Medicare/Medicaid Crossover Billing Instructions
BIN.1102. JFS 6780, For Medicare Part C	BIN.1103. Medicare Part C Cost Sharing Billing Instructions	BIN.1201. Claim Submission	BIN.1202. Remittance Advice
BIN.1203. Adjustments to Paid Claims	BIN.1204. Adjustment Reason Codes	BIN.1205. Resubmission of Denied Claims	BIN.1206. JFS 06653 Medical Claim Review Request Form
BIN.1207. JFS 06614, Health Insurance Fact	BIN.1208. Prompt Payment and Interest Provisions	BIN.1301. Third Party Carrier Information

Beginning August 1, Medicaid providers will no longer receive paper copies of Medicaid transmittal letters. Instead, they may sign up to receive communication electronically by submitting their names and e-mail addresses to http://www.odjfs.state.oh.us/subscribe/.

Transmittal letters notify Medicaid providers, county agencies and other stakeholders about rule and policy changes and clarifications. A new rule - Ohio Administrative Code (OAC) 5101:3-1-17.1 , "Notification of rule and program changes" - allows ODJFS to communicate rule changes electronically to those who might be affected by them. A person interested in receiving such an electronic communication must sign up at the Web site above. ODJFS will continue to post changes to: http://emanuals.odjfs.state.oh.us/emanuals.

The move to electronic letter transmission is part of a statewide effort to reduce costs and increase efficiencies while at the same time maintaining good customer service and due diligence. ODJFS remains

committed to working closely with Medicaid providers to ensure delivery of services to Ohioans. The agency urges Medicaid providers to submit their e-mail addresses to http://www.odjfs.state.oh.us/subscribe/ so they may stay informed of changes.