Authorization, Rates and Billing Information

As of September 1, 2022, DDD is processing all claims via the Wellsky system. Vendors have three options for submitting claims:

• Submit an electronic 837 form
• Manually enter claims directly in Wellsky for each authorization
• Submit a CMS 1500 form in paper form. CMS 1500 Form Billing Guide

Along with using the proper HCPCS/CPT codes, the rates will be adjusted to match the appropriate billing unit. Most of the HCPCS/CPT codes are billed in 15-minute increments. The adjustment to the rates will be a calculation to adjust from an hourly rate to a 15-minute rate. This adjustment will not decrease the revenue in comparison to billing for a full hour.

WellSky Frequently Asked Questions

The Division has created a Frequently Asked Questions document that is continually updated.

*Updated* WellSky System Issues/Updates/Fixes

Frequently Asked Questions

Claims submittal training and assistance is available and can be arranged through DDD’s Customer Service, Provider Relations Unit at [email protected]. Or, call the Provider Relations Unit at 1-844-770-9500 with your billing and claims submission questions.

WellSky Resources

• WellSky General Topics and Frequently Asked Questions
• Billing Guide: CMS 1500 Form
• WellSky 837P Companion Guide
• DDD Medical Coding with Modifiers Reference Sheet
• DDD Provider Coding Guide: Rate Book Companion
• Vendor Reimbursement Rate Sheet
• Division Provider Policy Manual Chapter 57 Third Party Liability
• Claims Technical Guidance Training Presentation
• Coding for Non-Coders Presentation (Video)
• Coding for Non-Coders Presentation (Slides)
• WellSky Claims Status Values Reference Guide 
• WellSky Training Session Videos
• Services with Unit Conversion 
• Error Codes & Descriptions
• Claim Denial Tips

Fee-for-Service Providers (Tribal Health Program)

Fee For Service (FFS)/Acute claims should be submitted on the appropriate CMS 1500, UB-04, or ADA 2012 claim form and submitted to DDD. This should include appropriate documentation for medical reviews, if needed. DDD Tribal Health Program Fee-for-Service Claims Submission Guide

Beginning April 1, 2022, fee-for-service providers will submit claims for services provided on or after April 1, 2022, using the AHCCCS online portal. More information is available on the Division's Fee-for-Service Providers Resources page.

A National Provider Identification (NPI) number is required of all health care providers who also bill Medicare for services provided to DDD members. The provider must report the NPI number to AHCCCS and include it on any DDD claim or the claim will be rejected. An NPI can only be obtained from the Centers for Medicare and Medicaid Services (CMS).

Getting an NPI is free. Not having one can be costly.

Get an NPI

Act now if you don’t have your NPI – further procrastination could disrupt your cash flow! It’s easy and it’s free! Apply for an NPI online

Share Your NPI

Have your NPI and don’t know what to do with it? Share it with DDD and the colleagues who rely on having your NPI to submit their claims (e.g., those who bill for ordered or referred services). You should also share it with your business associates, such as a billing service, vendor, or clearinghouse.

NPI Disclosures by Industry Entities to Industry Entities

The CMS NPI website provides guidance relating to the disclosure of health care providers’ NPIs by health industry entities for the purpose of using NPIs in HIPAA standard transactions.

Still Confused?

Not sure what an NPI is and how you can get it, share it, and use it? More information and education on the NPI can be found on the NPI page on the CMS web site. Providers can apply for an NPI online or call the NPI enumerator to request a paper application at (800) 465-3203.