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County Jail Medical Claims Billing. ND Department of Human Services Medical Services Division. October 8, 2012. Member Enrollment Form. Member Dis-Enrollment Form. $30 Per Claim Processed. $ Amount Paid For the Service (using ND Medicaid fee schedule). +. - PowerPoint PPT Presentation
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ND Department of Human Services
Medical Services Division
County Jail Medical Claims Billing
October 8, 2012
Member Enrollment FormND Department of Human Services, Medical Services Division 2
Member Dis-Enrollment FormND Department of Human Services, Medical Services Division 3
County Jail Medical Claims Billing Invoice
$30Per ClaimProcessed
$ Amount Paid
For the Service
(using ND Medicaid fee schedule)
+
ND Department of Human Services, Medical Services Division 4
ND Department of Human Services, Medical Services Division 5
SAMPLE
ND Department of Human Services, Medical Services Division 6
SAMPLE
ND Department of Human Services, Medical Services Division 7
SAMPLE
Processing Fee
Direct Questions to: Maggie Anderson, 701-328-1603 or
via email at [email protected]
Forms Inquiries:Mary Lou Thompson, 701-328-2322 or
via email at [email protected]
Claims Inquiries: Provider Relations, 701-328-4043
ND Department of Human Services, Medical Services Division 8
