Billing & Payment Information
Total Physicians, Hospitals & Others
|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
|Claims Status:||Claims Status Form
|Paper Claims:||Paper claims must be standardized to meet
imaging specifications as follows:
|Insurance Refund Request||Insurance Refund Request Form|
- 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.
|Behavioral Health Claims:||Submit claims to Beacon Health Options
Contact Beacon Health Options at 855-377-2416
|NDC Claims||Submit 11 digit National Drug Code (NDC) with
corresponding procedure code.
Visit the CMS website for helpful information, using the links below: