Providers

Billing & Payment Information

PAYER ID:	38201
THC preferred clearinghouses:	Emdeon, Ingenix, Netwerkes
Claim Address:	Total Health Care Inc, Michigan P.O. Box 21486 Eagan, MN 55121-0486
EFT	EFT Enrollment Authorization Form
EOP/Remittance Advice:	Available online ONLY. Registration Form for first time users
Filing Limit:	365 days from date of service. Appeals and resubmission of unclean claims must be received within 180 days from the original denial date
Billing Guidelines	THC follows Medicaid billing guidelines for all lines of business. CMS edits apply according to Medicaid rules.
Claims Status:	Claims Status Form
Claims Manual:	Claims Manual
Appeal Process	Policy
Paper Claims:	Paper claims must be standardized to meet imaging specifications as follows:
Insurance Refund Request	Insurance Refund Request Form

DO’S

Use only the red and white CMS 1500 claim form with pre-printed patch code for all submissions including status claims. No copies or other forms will be accepted.
Use only the red and white UB 04 OCR/original claim for all submissions including status claims. No copies or other forms will be accepted.
Make certain print type on the claim is a dark and legible print and printed within the correct column/ box. Make certain that no data is on the red dividing line.
Eliminate all character symbols, i.e., periods, commas, etc.

Do NOT cut perforated forms. The claim forms should be separated in a burster or hand separated.
Do NOT handwrite on the claims forms. Type all claim information and comments.
Do NOT staple claims and attachments.