How to submit claims to DHS

Do you have questions about how to correctly submit claims to DMAP so that they are processed and paid the first time? The handbooks and slide shows on this page can help answer your questions. Please use these documents in conjunction with your provider specialty's administrative rules, DMAP's General Rules, and Supplemental Information documents. For a link to the rules and guidelines for your provider type, click here.

• Handbooks
• Line-by-line instructions
• Where to find billing forms

If you use the Provider Web Portal or Electronic Data Interchange (EDI), you don't need to use paper billing forms. For more information about submitting Web claims, view the Web handbooks listed below or go to the Provider Web Portal information page. For more information about EDI, go to the EDI - Getting Started page.

_______________________________________________________________________________________________ 

If you have questions about which format to use, or have other billing questions not answered by these documents, you can call DMAP Provider Services at 800-336-6016, or e-mail them at dmap.providerservices@state.or.us.

Handbooks

• Dental Billing Instructions (paper) (Web): How to submit ADA 2006 dental claims.  
• Institutional Billing Instructions (paper)) (Web): How to submit institutional claims. Web handbooks include crossover claim instructions. 
• Professional Billing Instructions (paper) (Web): How to submit professional CMS-1500 claims. Web handbooks include crossover claim instructions.
• DMAP 505 Billing Instructions (PDF): How to submit the DMAP 505, Medicare/Medicaid Billing Invoice for Medical Practitioner Claims. This form is used for billing dual-coverage (Medicare and Medicaid) clients.
• Claim Adjustment Instructions (paper) (Web): How to submit the DMAP 1036, Individual Adjustment Request or adjust a claim on the Web.

Common FFS billing errors - updated 2/20/09 (PDF): This document shows resolutions to various Explanation of Benefit (EOB) codes that appear on your fee-for-service Remittance Advice.

DMAP 1036 Reminders for Nursing Facilities (PDF) - This document contains helpful reminders for when to use the DMAP 1036 form and how to complete the form.

Line-by-line instructions

The following slide shows present line-by-line billing instructions for DMAP providers for a variety of claim types.

Where to find billing forms

The DMAP 1036 and DMAP 505 forms are available on the DMAP forms page. You can also order hard copy versions of these forms using the DMAP 2420 (Provider Forms Request).

DMAP does not supply the CMS 1500, ADA or UB claim forms. Sample forms and information about how to order these forms are available in the Supplemental Information document on your provider type's rulebook page.