Required Information for Configuration

In order to set up in-house billing, a few key pieces of information are needed! Please supply the following:

• An NPI for your top-level organization (ISD, LEA, etc.). Should be a 10 digit identifier.
  (Format: 1234567890)

• An EIN for your top-level organization. Should be a 9 digit identifier.
  (Format: XX-XXXXXXX)

• The nine-digit zip code for every location you wish to bill for services performed (For instance, if a district has two high schools, two middle schools, and four elementary schools, you’d be supplying a total of 8 zip codes). Please note that the five digit zip code is not sufficient.
  (Format: XXXXX-XXXX)

Please complete the form (linked here), with all required information, and then share with bhworks.

If the above pieces of information are incorrect/missing, it will lead to a rejection of all relevant claims.

Documentation Checklist

• Consent: all services require consent to be billed, even screening or crisis services (consent should not be a barrier to performing a crisis service, but it is a barrier to billing the service).
  
  

• POC: most services require a POC to be billed. For services where a POC is required, the POC must be signed by the date of the service for the service to pass our validations.
  
  

• Service and Diagnosis Codes: all services must have a valid CPT service code and ICD-10 diagnosis code (“Reason to Treat”, either Z-code or F-code) in order to be billed. There are no exceptions, (this applies even for services done in Tier 1 or Tier 2).
  
  

• Provider Order: most nursing services require a Provider Order to be billed. For services where a Provider Order is required, it must be signed by the date of service for the service to pass our validations. The order must also list the billing code for the service being performed as one of the “ordered services”.

  • Please note that for some nursing services to be billed, the Provider Order must include the NPI of the provider giving the order.
    
    

• Tier 3 services require a CASII-LOCUS to be billed. For services where a CASII-LOCUS is required, it must be completed before the date of service for the service to pass our validations.

Adding mdlogix as a Trading Partner

• Please follow these video instructions, starting at 4:43.Part 10 of 12: Adding Delegates and Trading Partners on the Provider Web Portal (PWP)
  
• Our Trading Partner Name is: mdlogix Inc
• Our Trading Partner ID is: 50989939
• Please select the following transactions: 270, 271, 837P, and 835