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PROMISe Provider Handbooks and Billing Guides

This section of the DHS website contains PROMISe™ provider handbooks and billing guides for all provider types. Some sections of these handbooks are currently under development and will be updated as additional content becomes available. Please choose the appropriate provider type or specialty below to view the PROMISe™ handbook and billing guide appropriate for you.

Note: The billing guides are in Adobe PDF format. You must have a copy of Adobe Acrobat Reader installed on your system to view them.

 Forms and Publications
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Provider ⇧Title ⇳Type ⇳Filter ⇳Field1 ⇳Field2 ⇳
Adult Autism Waiver CMS-1500 (02 / 12) Billing Guide for PROMISe™ Adult Autism Waiver - ICD-10 version (04 / 17) Billing GuideChoice 3  
Adult Autism Waiver 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Aging Waiver Services Providers CMS-1500 (02 / 12) Aging Waiver Billing Guide - ICD-10 version  (01 / 17) Billing GuideChoice 3  
Aging Waiver Services Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Ambulance Companies CMS-1500 (02 / 12) Billing Guide for PROMISe™ Ambulance Providers - ICD-10 version (09 / 15) Billing GuideChoice 3  
Ambulance Companies 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Ambulatory Surgical Centers (ASCs) UB-04 Billing Guide for PROMISe™ Ambulatory Surgical Centers - ICD-10 version (07 / 18) Billing GuideChoice 3  
Ambulatory Surgical Centers (ASCs) 837 Institutional / UB-04 Claim Form HandbookChoice 3  
Attendant Care CMS-1500 (02 / 12) Billing Guide for PROMISe™ - Attendant Care Providers - ICD-10 version (01 / 17) Billing GuideChoice 3  
Attendant Care 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Audiologists CMS-1500 (02 / 12) Billing Guide for PROMISe™ Audiologists Billing GuideChoice 3  
Audiologists 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Birthing Centers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Birthing Centers - ICD-10 version (09 / 15) Billing GuideChoice 3  
Birthing Centers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Case Managers CMS (02 / 12) Billing Guide for PROMISe™ Case Managers - ICD-10 version (07 / 17) Billing GuideChoice 3  
Case Managers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Certified Registered Nurse Anesthetists (CRNAs) CMS-1500 (02 / 12) Billing Guide for PROMISe™ Certified Registered Nurse Anesthetists - ICD-10 version (09 / 15) Billing GuideChoice 3  
Certified Registered Nurse Anesthetists (CRNAs) 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
Certified Registered Nurse Practitioners (CRNPs) 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Chiropractors CMS-1500 (02 / 12) Billing Guide for PROMISe™ Chiropractors - ICD-10 version (09 / 15) Billing GuideChoice 3  
Chiropractors 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Cleft Palate Providers 837 ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23) Billing GuideChoice 3  
Cleft Palate Providers 837 837 Dental / ADA – Version 2023 Claim Form (11 / 23) HandbookChoice 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 GuideChoice 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 HandbookChoice 3  
COMMCARE Waiver Services Providers CMS-1500 (02 / 12) Billing Guide for PROMISe™ COMMCARE Waiver Services - ICD-10 version (01 / 17) Billing GuideChoice 3  
COMMCARE Waiver Services Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Dental Anesthesiologists ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23) Billing GuideChoice 3  
Dental Anesthesiologists 837 Dental / ADA – Version 2023 Claim Form (11 / 23) HandbookChoice 3  
Dentists (General) ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23) Billing GuideChoice 3  
Dentists (General) 837 Dental / ADA – Version 2023 Claim Form (11 / 23) HandbookChoice 3  
Dentists (General) Dental Provider Handbook (837 Dental / ADA Version 2023 Claim Form) HandbookChoice 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 GuideChoice 3  
Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Services 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Employment Competitive Providers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Employment Competitive Providers - ICD-10 version (09 / 15) Billing GuideChoice 3  
Employment Competitive Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Endodontists ADA Claim Form – Version 2019 Completion Aid for Dentists – Prior Authorization (04 / 23) Billing GuideChoice 3  
Endodontists 837 Dental / ADA – Version 2023 Claim Form (11 / 23) HandbookChoice 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 GuideChoice 3  
Extended Care Facilities for Respite Care Services 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
Family Planning Clinics – Title XIX Only 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Federally Qualified Health Centers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Rural Health Clinics (RHCs) & Federally Qualified Health Centers (FQHCs) - ICD-10 version (12 / 17) Billing GuideChoice 3  
Federally Qualified Health Centers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Federally Qualified Health Centers Appendix E-FQHC / RHC Handbook HandbookChoice 3  
Federally Qualified Health Centers FQHC / RHC Medicare Part B / Medicare Advantage / Private Third Party Billing Instructions for Dental Encounters HandbookChoice 3  
Funeral Directors CMS-1500 (02 / 12) Billing Guide for PROMISe™ Funeral Directors - ICD-10 version (09 / 15) Billing GuideChoice 3  
Funeral Directors 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 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 HandbookChoice 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 GuideChoice 3  
Healthy Beginnings Plus (HBP) Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
Home and Community Habilitation Services Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Home Health Agency Providers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Home Health Agencies - ICD-10 version (01 / 17) Billing GuideChoice 3  
Home Health Agency Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Homemaker Agency Providers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Homemaker Agency Providers - ICD-10 version (11 / 16) Billing GuideChoice 3  
Homemaker Agency Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Home Residential Rehabilitation Providers CMS-1500 (02 / 12) Billing Guide for PROMISe(TM) Home Residential Rehabilitation Providers - ICD-10 version (03 / 18) Billing GuideChoice 3  
Home Residential Rehabilitation Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Hospice Providers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Hospice Providers - ICD-10 version (01 / 17) Billing GuideChoice 3  
Hospice Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Independence & OBRA Waiver Providers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Independence and OBRA Waiver Providers - ICD-10 version (01 / 17) Billing GuideChoice 3  
Independence & OBRA Waiver Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Inpatient Hospitals UB-04 Billing Guide for PROMISe™ Inpatient Hospitals - ICD-10 version (07 / 18) Billing GuideChoice 3  
Inpatient Hospitals 837 Institutional / UB-04 Claim Form HandbookChoice 3  
Inpatient Psychiatric Hospitals/Psychiatric Facilities UB-04 Billing Guide for PROMISe™ Inpatient Psychiatric Hospitals / Facilities - ICD-10 version (07 / 18) Billing GuideChoice 3  
Inpatient Psychiatric Hospitals/Psychiatric Facilities 837 Institutional / UB-04 Claim Form HandbookChoice 3  
Inpatient Rehabilitation Hospitals/Rehabilitation Facilities UB-04 Billing Guide for PROMISe™ Inpatient Rehabilitation Hospitals & Facilities - ICD-10 version (07 / 18) Billing GuideChoice 3  
Inpatient Rehabilitation Hospitals/Rehabilitation Facilities 837 Institutional / UB-04 Claim Form HandbookChoice 3  
Intensive Behavioral Health Services (IBHS) CMS-1500 Claim Form Completion for PROMISe™ Intensive Behavioral Health Services (IBHS) Providers Billing GuideChoice 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 GuideChoice 3  
Intermediate Care Facilities for Other Related Conditions (ICF/ORC) 837 Institutional / UB-04 Claim Form HandbookChoice 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 GuideChoice 3  
Intermediate Care Facilities for the Mentally Retarded (ICF/MR) 837 Institutional / UB-04 Claim Form HandbookChoice 3  
Intermediate Service Organizations CMS-1500 (02 / 12) Billing Guide for PROMISe™ Intermediate Service Organizations (ISOs) - ICD-10 version (07 / 17) Billing GuideChoice 3  
Intermediate Service Organizations 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
JCAHO Residential Treatment Facilities (RTFs) 837 Institutional / UB-04 Claim Form HandbookChoice 3  
Laboratories CMS-1500 (02 / 12) Billing Guide for PROMISe™ Laboratories - ICD-10 version (01 / 17) Billing GuideChoice 3  
Laboratories 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
LTC Exceptional Grant Payment Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
LTC Medicare Deductible & Coinsurance Payments CMS-1500 (02 / 12) Billing Guide for PROMISe™ Nursing Facilities - ICD-10 version (01 / 17) Billing GuideChoice 3  
LTC Medicare Deductible & Coinsurance Payments 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
MA Early Intervention (EI) Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
Medically Fragile Foster Care Providers 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Medical Suppliers CMS-1500 (02 / 12) Billing Guide for PROMISe™ Medical Suppliers - ICD-10 version (01 / 17) Billing GuideChoice 3  
Medical Suppliers 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
Mental Health & Substance Abuse Providers (Including Outpatient Psychiatric Partial Hospitalization) 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Midwives CMS-1500 (02 / 12) Billing Guide for PROMISe™ Midwives - ICD-10 version (12 / 17) Billing GuideChoice 3  
Midwives 837 Professional / CMS-1500 Claim Form HandbookChoice 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 GuideChoice 3  
Non-JCAHO Residential Treatment Facilities (RTFs) 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
Nurse CMS-1500 (02 / 12) Billing Guide for PROMISe™ Nurses - ICD-10 version (01 / 17) Billing GuideChoice 3  
Nurse 837 Professional / CMS-1500 Claim Form HandbookChoice 3  
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