Loading
Get 837i Chemical Dependency Outpatient - Dhs State Mn
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the 837I Chemical Dependency Outpatient - Dhs State Mn online
Completing the 837I Chemical Dependency Outpatient form is essential for requesting reimbursement for chemical dependency non-residential services. This guide will provide step-by-step instructions to help users navigate the online form efficiently.
Follow the steps to fill out the form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Log in to MN–ITS. From the left menu, select MN–ITS, then Submit Interactive Claims (837), and finally Outpatient (837I).
- In the Subscriber tab, enter the required recipient information: member number, birth date (MMDDYYYY format), last name, first name, gender, address, city, state (MN), and zip code.
- In the Providers tab, confirm Billing Provider information is auto-populated. If required, enter the NPI for the attending physician and select from the provider type drop-down menu.
- Navigate to the COB tab. If applicable, enter information about third-party liability, including payer name, primary ID, prior payment, and adjustments.
- Proceed to the Claim Information tab. Enter the type of bill (891 or 131), statement dates, and other required admission details. Include the highest specificity ICD-CM-9 code.
- In the Services tab, enter the date services were provided, revenue and procedure codes, units charged, and total charge for each line item.
- Validate your claim by clicking the Validate button, reviewing the response, and making necessary corrections.
- Submit your claim by clicking the Submit button. You will receive a Claim Response with a Payer Claim Control number.
- You can copy a claim by selecting the Copy Claim button and choosing the desired screens before submitting updates.
Complete your documents online for efficient processing.
245G in Minnesota refers to the statute that governs the licensing of substance use treatment programs. This legislation outlines standards and expectations for services offered to individuals seeking recovery. It plays a crucial role in maintaining quality care in services such as 837I Chemical Dependency Outpatient - Dhs State Mn. Understanding these regulations can help individuals make informed choices about treatment options.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.