How to Use DDE

1. How to Use DDE Professional Billing

3. Go to www.medicaid.state.ar.us Click on �Provider� Click on �Log on� Enter the provider�s 9-digit Medicaid ID number (PIN) as the User ID The setup password is the provider�s SSN (will be prompted to change) Click the Submit button Log On

5. Header: Submitter Information

6. Entity Type Enter person Last/Organization Name/First Name Enter the Provider last and first name Electronic Transmitter ID Enter eight zeroes: 00000000 Name/Telephone number Enter your name and phone number, including area code Submitter

7. Header: Billing Provider

8. Medicaid Provider ID/NPI Enter the provider�s Medicaid ID number and leave the NPI field blank Billing Provider

9. Header: Subscriber Information

10. Enter the beneficiary�s information Last Name First Name Middle Name (not required) Medicaid beneficiary ID number Address, including City, State, Zip Birth Date Format is MMDDYYYY If DOB is 01/01/2010, enter 01012010 Gender Subscriber

11. Header: Claim Information

12. Patient Account Number 12345 Place of Service Place of service - Enter 12 Claim Information

13. Header: Diagnosis Codes

14. Principal Diagnosis Information Enter the primary diagnosis code Do not include the decimal Example: If DX is 111.11, enter 11111 Other Diagnosis Information Enter additional diagnosis codes if applicable Diagnosis Codes

15. Services: Add Service to Claim

16. Procedure Enter S5125 Charge The dollar amount that you are billing. Using the Pay Grid that follows, enter the Billing Amount for the hours you worked. Quantity Units of time that you worked. Using the Pay Grid that follows, enter the Units Worked for the hours you worked. Diagnosis Code Pointer Enter 1 Add Service to Claim

17. Pay Grid

18. Pay Grid

19. Services: Service Date/NDC Info

20. Service Date Period (first day worked) Enter the From and To date of service � (1 day) � same date Format is MMDDYYYY If the date of service is 1/1/2010, enter 01012010 Click Add Services: Service Date/NDC Info

21. Services: Adding the Service

22. Once you click the Add button, it will add your service to the top of the screen Once you have added the service, you can add a second service, third service, etc. Click Submit Adding Service (Additional Days) on Claim/Submit Claim