N.H. Medicaid Hospice Provider Manual, Vol. II, § 11

Please Note: Until notified otherwise, hospice providers must submit claims only as paper

claims and must submit the paper claims directly to the Department address noted below -

not to the fiscal agent, Xerox. Hospice providers are expected to comply with all

requirements of this Section 11, "Claims," except for requirements related to non-paper

billing and the submittal of claims to Xerox. Hospice claims should be submitted on paper

directly to:

Department of Health and Human Services

129 Pleasant Street

Office of Medicaid Business and Policy

Brown Building

Concord, NH 03301

Attention: Patricia Dean

Hospice providers shall submit claims for payment to Xerox, the Department’s fiscal agent.

All providers participating in NH Medicaid must submit claims to the fiscal agent in accordance with NH

Medicaid guidelines. Providers should note that NH Medicaid claim completion requirements may be

different than those for other payers, previous fiscal agents, or fiscal agents in other states.

Providers participating in NH Medicaid are responsible for timely and accurate billing. If NH Medicaid

does not pay due to billing practices of the provider which result in non-payment, the provider cannot bill

the member.

Claim completion guidelines in this manual should be followed for instructions on specific fields. The

NH Specific Companion Guide, which can be found at www.nhmmis.nh.gov, (see provider manuals

under the provider tab) should be used for electronic claim filing instructions. While field-by-field

requirements are shown for paper claims; the same required data is captured through web portal claim

entry and through electronic submissions to EDI. Web portal submissions feature step-by-step claim

completion instructions as well as tools such as Online Help to assist providers in correct claim

completion.

Regardless of the method claims are submitted, information submitted on the claim by the provider

represents a legal document. Neither the fiscal agent nor State staff can alter any data on a submitted

claim.

The following claim-related topics are found in the General Billing Manual – Volume I:

•

Claims Submission via EDI, web portal, paper

•

Claims processing – edits & audits, transaction control numbers, line item vs. header processing,

claim status, remark/EOB codes

•

Claim Resubmission

•

Claim adjustments and voids

•

Medicare cross-overs

•

Claims payment

•

Remittance Advice

Providers will be notified of payment or denial via a Remittance Advice, usually received in electronic

format or via the web portal.

Denied claims should be resubmitted only if the reason for the denial has been corrected.

Paid claims cannot be resubmitted; resubmission of a paid claim will result in a denial as a duplicate.

Paid claim corrections must be made through the adjustment process. If a paid claim has a line item

denial, the individual line charge can be resubmitted.

Corrected claims and denied line items can be resubmitted only if the denial was due to erroneous,

updated or missing information which is now corrected. Providers should never resubmit claims that are

currently in process (suspended).

Any claim denied for failure to be submitted or resubmitted in accordance with timely filing standards

will not be paid. Denied claims that have been corrected must be resubmitted as a new claims transaction

on paper, via the web portal, or electronically via EDI.