N.H. Admin. Code § He-C 6341.13

Current through Register No. 50, December 12, 2024

Section He-C 6341.13 - Billing Process for Communication Access Services

(a) Providers shall request Form 2110 "Service Authorization" (June 2008 Edition) from DCYF prior to service delivery.

(b) Services provided without Form 2110 "Service Authorization" (June 2008 Edition), shall not be paid.

(c) Providers shall bill the department through NH Bridges via paper claims or electronic claims submission.

(d) For paper claim submission, a provider shall:

(1) Copy Form 2110 "Service Authorization" (June 2008 Edition), for future billings if the authorized service dates span a date range;

(2) Forward the completed and signed Form 2110 "Service Authorization" (June 2008 Edition) to the department; and

(3) Attach an invoice to the Form 2110 "Service Authorization" (June 2008 Edition) that details dates and number of hours interpreting services were provided.

(e) For electronic claims submission, a provider shall:

(1) Request a web billing account from DHHS by submitting a completed, signed, and dated Form 2679 "Provider Web Billing User Account Request Form" (February 2017 Edition) that includes the following certification statements:

"I understand that provider billing requirements are governed by administrative rules (He-C 6339, He-C 6340, He-C 6348, He-C 6350, He-C 6914) which is incorporated herein by reference and I agree to abide by these requirements.";

"I understand and agree that as a provider, I am responsible for any and all billing invoices submitted by me or on my behalf by my authorized representative, whether user is an employee authorized as a billing representative or authorized billing representative of a management service company.";

"I understand and agree that any payments made which are based on inaccurate or fraudulent billing, whether submitted by me or by my authorized user will be recovered from me by DHHS.";

"I understand and agree that it is my responsibility to notify the Division for Children, Youth, and Families by contacting Provider Relations when a user no longer required access to the web billing application.";

"I understand that by submitting an invoice via the Provider Web Billing Application I am certifying that the invoice is true and accurate.";

"I understand and agree that information obtained via the Provider Web Billing Application is confidential and can be used solely for the purposes of administering Division for Children, Youth, and Families (DCYF) Services.";

"I understand and agree that I am responsible for my authorized representative, employee, and/or any management service company's use of the Provider Web Billing Application."; and

"I understand and agree that I must access my web account at least every ninety (90) days or my account will be de-activated."; and

(2) Be issued a log in and personal identification number (PIN) by DHHS for use in accessing the web billing account.

(f) Neither the provider of any authorized representative shall transfer his or her log in or PIN or allow use of his or her log in or PIN by any other person.

N.H. Admin. Code § He-C 6341.13

(See Revision Note at part heading for He-C 6341) #9392, eff 3-1-09

Amended by Volume XXXVIII Number 23, Filed June 7, 2018, Proposed by #12535, Effective 5/24/2018, Expires 11/20/2018.

Amended by Volume XXXVIII Number 50, Filed December 13, 2018, Proposed by #12684, Effective 11/30/2018, Expires 11/30/2028.