Wash. HCA Hospice Services Billing Guide, How do I bill claims electronically?

Instructions on how to bill Direct Data Entry (DDE) claims can be found on HCA’s

Billers, providers, and partners webpage, under Learn how to use ProviderOne,

select Webinars.

For information about billing Health Insurance Portability and Accountability Act

(HIPAA) Electronic Data Interchange (EDI) claims, see the ProviderOne 5010

companion guides on the HIPAA Electronic Data Interchange (EDI) webpage.

The attending provider must be included on the claim, or the claim will be

denied.

The following institutional claim instructions relate to hospice services:

Description

Field

Required Entry

Type of

Facility

Yes Choose 8-Special Facility

Bill

Classification

Yes These types of Bill Codes are to be used to correctly identify Washington

State Medicaid Hospice Claims:

1S –Hospice (non-hospital-based)

2S – Hospice (hospital-based)

Value Code

and Value

Amount

Situational Use this field to report a client’s Participation amount.

Enter code 31 (Patient Liability Amount) in the Value Code field and the

client’s total participation from the award letter in the Value Amount field.

Discharge

Status

Yes See the National Uniform Billing Committee (NUBC)

The following professional claim instructions relate to hospice services:

Name Field Required Entry

Claim Note When applicable If the client does not have Part A coverage, enter the statement

“Client has Medicare Part B coverage only” in this field.

Code(s) only appropriate for Washington State Medicaid:

Name Field Required

Code Number

Entry To Be Used For

Place of Service Yes 12 Client’s Residence

Place of Service Yes 21 Inpatient Hospital

Place of Service Yes 23 Emergency Room

Place of Service Yes 24 Outpatient Hospital, Office or

Ambulatory Surgery Center

Place of Service Yes 31 Nursing Facility

Place of Service Yes 34 Hospice Care Center

Place of Service Yes 99 Other

*Units field is required. Entry code should be 1.

External cause codes (V00-Y99) are required to be submitted in groups of three

for a claim to be processed. For questions email: HIPAA-Help@hca.wa.gov.