Adult Autism Waiver |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Adult Autism Waiver - ICD-10 version (04 / 17)
| Billing Guide | Choice 3 | | |
Adult Autism Waiver |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Aging Waiver Services Providers |
CMS-1500 (02 / 12) Aging Waiver Billing Guide - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Aging Waiver Services Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Ambulance Companies |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Ambulance Providers - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Ambulance Companies |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Ambulatory Surgical Centers (ASCs) |
UB-04 Billing Guide for PROMISe™ Ambulatory Surgical Centers - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
Ambulatory Surgical Centers (ASCs) |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Attendant Care |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ - Attendant Care Providers - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Attendant Care |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Audiologists |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Audiologists
| Billing Guide | Choice 3 | | |
Audiologists |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Behavioral Health Rehabilitation Services (BHRS) BSC, BSC-ASD, MT, and TSS |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Behavioral Health Rehabilitation Services (BHRS) BSC, BSC-ASD, MT, and TSS Providers - ICD-10 version (07 / 17)
| Billing Guide | Choice 3 | | |
Behavioral Health Rehabilitation Services (BHRS) BSC, BSC-ASD, MT, and TSS |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Birthing Centers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Birthing Centers - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Birthing Centers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Case Managers |
CMS (02 / 12) Billing Guide for PROMISe™ Case Managers - ICD-10 version (07 / 17)
| Billing Guide | Choice 3 | | |
Case Managers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Certified Registered Nurse Anesthetists (CRNAs) |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Certified Registered Nurse Anesthetists - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Certified Registered Nurse Anesthetists (CRNAs) |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Certified Registered Nurse Practitioners (CRNPs) |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Certified Registered Nurse Practitioners (CRNP) - ICD-10 version (12 / 17)
| Billing Guide | Choice 3 | | |
Certified Registered Nurse Practitioners (CRNPs) |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Chiropractors |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Chiropractors - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Chiropractors |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Cleft Palate Providers 837 |
ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23)
| Billing Guide | Choice 3 | | |
Cleft Palate Providers 837 |
837 Dental / ADA – Version 2019 Claim Form (04 / 23)
| Handbook | Choice 3 | | |
Clinics (except Outpatient Hospital Clinics) – includes Independent Medical/Surgical Clinics, Outpatient Drug & Alcohol Clinics, and Outpatient Psychiatric Clinics |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Clinics - ICD-10 version (12 / 17)
| Billing Guide | Choice 3 | | |
Clinics (except Outpatient Hospital Clinics) – includes Independent Medical/Surgical Clinics, Outpatient Drug & Alcohol Clinics, and Outpatient Psychiatric Clinics |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
COMMCARE Waiver Services Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ COMMCARE Waiver Services - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
COMMCARE Waiver Services Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Dental Anesthesiologists |
ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23)
| Billing Guide | Choice 3 | | |
Dental Anesthesiologists |
837 Dental / ADA – Version 2019 Claim Form (04 / 23)
| Handbook | Choice 3 | | |
Dentists (General) |
ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23)
| Billing Guide | Choice 3 | | |
Dentists (General) |
837 Dental / ADA – Version 2019 Claim Form (04 / 23)
| Handbook | Choice 3 | | |
Dentists (General) |
Dental Provider Handbook (837 Dental / ADA Version 2019 Claim Form)
| Handbook | Choice 3 | | |
Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Services |
CMS (02 / 12) Billing Guide for PROMISe™ Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Services – ICD-10 version (12 / 17)
| Billing Guide | Choice 3 | | |
Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Services |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Employment Competitive Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Employment Competitive Providers - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Employment Competitive Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Endodontists |
ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23)
| Billing Guide | Choice 3 | | |
Endodontists |
837 Dental / ADA – Version 2019 Claim Form (04 / 23)
| Handbook | Choice 3 | | |
Extended Care Facilities for Respite Care Services |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Extended Care Facilities (ECFs) - Respite Care Services - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Extended Care Facilities for Respite Care Services |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Family Planning Clinics – Title XIX Only |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Family Planning Councils - Title XIX Only - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Family Planning Clinics – Title XIX Only |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Funeral Directors |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Funeral Directors - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Funeral Directors |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
General Hospitals (including Outpatient Hospital Clinic, Emergency Room, Hospital Short Procedure Unit (SPU), and Outpatient Rehabilitation Hospital providers) |
UB-04 Billing Guide for PROMISe™ Outpatient Hospitals - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
General Hospitals (including Outpatient Hospital Clinic, Emergency Room, Hospital Short Procedure Unit (SPU), and Outpatient Rehabilitation Hospital providers) |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Healthy Beginnings Plus (HBP) Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Healthy Beginnings Plus (HBP) Providers - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Healthy Beginnings Plus (HBP) Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Home and Community Habilitation Services Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Home and Community Habilitation Providers - ICD-10 version (03 / 18)
| Billing Guide | Choice 3 | | |
Home and Community Habilitation Services Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Home Health Agency Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Home Health Agencies - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Home Health Agency Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Homemaker Agency Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Homemaker Agency Providers - ICD-10 version (11 / 16)
| Billing Guide | Choice 3 | | |
Homemaker Agency Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Home Residential Rehabilitation Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe(TM) Home Residential Rehabilitation Providers - ICD-10 version (03 / 18)
| Billing Guide | Choice 3 | | |
Home Residential Rehabilitation Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Hospice Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Hospice Providers - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Hospice Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Independence & OBRA Waiver Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Independence and OBRA Waiver Providers - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Independence & OBRA Waiver Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Inpatient Hospitals |
UB-04 Billing Guide for PROMISe™ Inpatient Hospitals - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
Inpatient Hospitals |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Inpatient Psychiatric Hospitals/Psychiatric Facilities |
UB-04 Billing Guide for PROMISe™ Inpatient Psychiatric Hospitals / Facilities - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
Inpatient Psychiatric Hospitals/Psychiatric Facilities |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Inpatient Rehabilitation Hospitals/Rehabilitation Facilities |
UB-04 Billing Guide for PROMISe™ Inpatient Rehabilitation Hospitals & Facilities - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
Inpatient Rehabilitation Hospitals/Rehabilitation Facilities |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Intensive Behavioral Health Services (IBHS) |
CMS-1500 Claim Form Completion for PROMISe™ Intensive Behavioral Health Services (IBHS) Providers
| Billing Guide | Choice 3 | | |
Intermediate Care Facilities for Other Related Conditions (ICF/ORC) |
UB-04 Billing Guide for PROMISe™ Intermediate Care Facilities for the Mentally Retarded (ICF / MR) & Intermediate Care Facilities for Other Related Conditions (ICF / ORC) - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
Intermediate Care Facilities for Other Related Conditions (ICF/ORC) |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Intermediate Care Facilities for the Mentally Retarded (ICF/MR) |
UB-04 Billing Guide for PROMISe™ Intermediate Care Facilities for the Mentally Retarded (ICF / MR) & Intermediate Care Facilities for Other Related Conditions (ICF / ORC) - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
Intermediate Care Facilities for the Mentally Retarded (ICF/MR) |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Intermediate Service Organizations |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Intermediate Service Organizations (ISOs) - ICD-10 version (07 / 17)
| Billing Guide | Choice 3 | | |
Intermediate Service Organizations |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
JCAHO Residential Treatment Facilities (RTFs) |
UB-04 Billing Guide for PROMISe™ Joint Commission on Accreditation of HealthCare Organizations (JCAHO) RTFs - ICD-10 version (07 / 18)
| Billing Guide | Choice 3 | | |
JCAHO Residential Treatment Facilities (RTFs) |
837 Institutional / UB-04 Claim Form
| Handbook | Choice 3 | | |
Laboratories |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Laboratories - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Laboratories |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
LTC Exceptional Grant Payment Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Nursing Facilities - Long Term Care Exceptional Payment Program - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
LTC Exceptional Grant Payment Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
LTC Medicare Deductible & Coinsurance Payments |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Nursing Facilities - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
LTC Medicare Deductible & Coinsurance Payments |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
MA Early Intervention (EI) Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ MA Early Intervention (EI) Providers - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
MA Early Intervention (EI) Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Medically Fragile Foster Care Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Medically Fragile Foster Care Providers - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Medically Fragile Foster Care Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Medical Suppliers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Medical Suppliers - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Medical Suppliers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Mental Health & Substance Abuse Providers (Including Outpatient Psychiatric Partial Hospitalization) |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Mental Health & Substance Abuse Providers - ICD-10 version (01 / 18)
| Billing Guide | Choice 3 | | |
Mental Health & Substance Abuse Providers (Including Outpatient Psychiatric Partial Hospitalization) |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Midwives |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Midwives - ICD-10 version (12 / 17)
| Billing Guide | Choice 3 | | |
Midwives |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Mobile Therapy Providers |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Behavioral Health Rehabilitation Services (BHRS) BSC, BSC-ASD, MT, and TSS Providers
| Billing Guide | Choice 3 | | |
Mobile Therapy Providers |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Non-JCAHO Residential Treatment Facilities (RTFs) |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Non-JCAHO Residential Treatment Facilities (RTFs) - ICD-10 version (09 / 15)
| Billing Guide | Choice 3 | | |
Non-JCAHO Residential Treatment Facilities (RTFs) |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |
Nurse |
CMS-1500 (02 / 12) Billing Guide for PROMISe™ Nurses - ICD-10 version (01 / 17)
| Billing Guide | Choice 3 | | |
Nurse |
837 Professional / CMS-1500 Claim Form
| Handbook | Choice 3 | | |