Use the above link for claims billed on and after May 13, 2015.
- Appendix A - Use Interactive Voice Response (IVR) to Verify Eligibility
- Appendix B - Verifying Eligibility Using a Magnetic Card Reader or MEV Service
- Appendix C - Managed Care Organizations (MCOs)
- Appendix D - Casualty Claims and Health Insurance Claims
- Appendix E - Benefit Services Packages
- Appendix F - Instructions to Fill Out the General Information for Authorization Request Form
- Appendix G - How to Check Status of an Authorization
- Appendix H - Cover Sheets for Backup Documentation
- Appendix I - Completing the CMS-1500 Claim Form
- Appendix J - Completing the UB-04 Claim Form
- Appendix K - Completing the 2012 ADA Dental Claim Form
- Appendix L - Taxonomy and ProviderOne
- Appendix M - Medicare Crossover Claim Payment Methodology
- Appendix N - Use the IVR to Check Claim Status
- Appendix O - Use the IVR to Check Warrants
Important: Please be sure to review the Fact Sheet for ICD-10 implementation.
Note: The Guide to Requesting Prior Authorization has been inserted into the ProviderOne Billing and Resource Guide starting on page 187.
Note: Please do not print these documents. The Health Care Authority may make occasional changes to reflect current policy, program updates, and ProviderOne system enhancements.
If you print the document and use the paper copy instead of the webpage, your version may become outdated. For best results, bookmark this page so that you are always using the most up-to-date version of the Guide.
View and download the following HCA forms which are discussed in this Guide:
- Authorization Agreement for Electronic Funds Transfer, form HCA 12-002
- Electronic Funds Transfer (EFT) Authorization Change, form HCA 12-003
Third Party Insurance Carrier Codes
Document Submission Cover Sheets