NPI is the National Provider Identifier, a HIPAA requirement. The NPI will be used by healthcare providers in filing and processing claims and other related transactions.
Per Centers for Medicare & Medicaid Services (CMS), providers are NOT permitted to bill patients for missed appointments. CMS Chicago Regional State Letter # 36‐95
Original claims must be received by Ohio Department of Medicaid (ODM) within 365 days of the actual date the service was provided. Inpatient hospital claims must be received within 365 days from the date of discharge. The “date of receipt” is the date ODM assigns an internal control number (ICN). Claims received beyond three hundred sixty‐five days from the actual date of service or hospital discharge will be denied except: When submission of a claim is delayed due to the pendency of an administrative hearing decision by ODM or an eligibility determination by a county department of job and family services (CDJFS), the claim must be received within 180 days from the date of the administrative hearing decision by ODM or the eligibility determination by the CDJFS, or When a claim cannot be submitted to ODM within 365 days of the actual date of service due to coordination of benefits delays with Medicare and/or other third party payers, the claim must be received by ODM within 180 days from the date Medicare or the other insurance plan paid the claim. (OAC Rule 5160‐1‐19)
Medicaid payment is payment‐in‐full. The Provider may not collect and/or bill the consumer for any difference between the Medicaid payment and the provider’s charge or request the consumer to share in the cost through a deductible, coinsurance, copayment or other similar charge, other than Medicaid co‐payments. The provider may not charge the consumer a down payment, refundable or otherwise. Providers may not bill the consumers in lieu of ODM unless: The consumer is notified in writing prior to the service being rendered that the Provider will not bill the department for the covered service, and the consumer agrees to be liable and signs a written statement to that effect, prior to the service being rendered, and the provider explains to the consumer that the service is a covered Medicaid service and other Medicaid providers may render the service at no cost to the consumer. (OAC Rule 5160‐1‐13.1)