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Claims Submission Quick Guide

 
 

Before you start the claims process REMEMBER:

  • Verify benefits first! If the patient has Medicare, Tricare or VA benefits. If so...
stop
  • The patients' care should be billed through their Medicare, Tricare, or VA benefits.
  • Please DO NOT file a claim through the NDMS Definitive Care Reimbursement Program.

HOWEVER, if the patient has...

CoverageBilling Action
Private Health Insurance or non-Federal Public Coverage other than MedicaidOther insurance billed as primary payer. NDMS billed as secondary payer for any unreimbursed amounts not to exceed 110% of Medicare rate for Hospitals with MOA or 100% of Medicare rate for Practitioners.
MedicareNDMS billed as primary payer.
Dual Eligible (Medicare and Medicaid)Medicare is the primary payer. Medicaid is the Secondary payer. Facility will submit EOB to NDMS in order to receive the 10% Admin fee. NDMS payer of last resort.

Benefit examples listed above are claim eligible! Use the Claims Submission.

Claims Submission Checklist

Ensure the NDMS Definitive Car​e Reimbursement Program has been activated.

Ensure the claim will fall under coverage guidelines.

Complete the Provider Registration forms, which includes:

  • W-9 Form

  • ACH Vendor Enrollment Form (Only fill in company and banking info)

  • NDMS Definitive Care Reimbursement Program Provider Enrollment Form

Complete the applicable claim forms:

  • Hospitals (CMS-1450)

  • Practitioners (CMS-1500)

Submit the claim and all Provider Registration Forms BEFORE the submission deadline by either.

  • Electronically via a claims clearinghouse service to payer code: NDMSA (HHS NATIONAL DISASTERMEDICAL SYSTEM-APPRIO)

    NDMSJ29 (HHS NATIONAL DISASTER MEDICAL SYSTEM-J-29)

    Providers should submit ALL claims electronically through a claims clearinghouse service to payer code NDMSJ29 (HHS National Disaster Medical System-J-29). For every electronic claim received, an electronic remittance advice will be returned, making payment reconciliation more efficient for providers. 

    This includes Secondary Claims submission for Coordination of Benefits (COB). After the primary insurance has processed the claim, include the remittance information from the primary payer in the 837 record. This helps streamline the process and ensures that all necessary information is available for the secondary payer.

    If you are unable to submit your claims electronically, hard-copy claims may be submitted to J29 using industry-standard pre-printed claim forms:
     

  • Institutional claims must be submitted using the CMS-1450 (UB-04) claim form.
     

  • Professional claims must be submitted using the CMS-1500 claim form.
     

  • Dental claims must be submitted using the ADA Dental claim form.
     

  • COB Claims must include a detailed EOB including provider payments and remittance advice.​
     

  • Secure Encrypted Email: NDMS.reimbursement@apprioinc.com

  • Fax: 1-202-892-7200

  • Mail: 
    c/o Apprio 
    425 3rd Street, SW, Suite 600 
    Washington, DC 20024

For more information, please visit the NDMS Definitive Care Reimbursement Program. There you will find coverage guidelines, downloadable forms in PDF format and answers to FAQs!

 
 

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