CMS-1500 claim form

How do I complete the CMS-1500 claim form?

The following CMS-1500 claim form instructions relate to the Hearing Hardware program. 

Field No: 19

Name : Reserved for Local Use

Field Required : When applicable

Entry : 

Enter: 

• “SCI=B” (Baby on parent’s ProviderOne Client ID); or 
•  Claim notes.

Field No: 23

Name : Prior Authorization Number

Field Required : When applicable

Entry : Use the prior authorization number assigned to you if/when services have been denied and you are requesting an exception to rule.

Field No: 24D

Name :  Procedures, Services or Supplies CPT/HCPCS

Field Required : Yes

Entry : Enter the appropriate Current Procedural Terminology (CPT) or Common Procedure Coding System (HCPCS) procedure code for the services being billed. Modifier: 

When appropriate enter a modifier.

Client Eligibility (DDA Clients) Developmental Disabilities Administration [DDA]

How can I verify a client’s eligibility? 

Providers must verify that a patient has a valid social services authorization for the date of service and that the client’s benefit package covers the applicable service. This helps prevent delivering a service the administration will not pay for. Providers can verify that a client has a valid social services authorization in ProviderOne. 

How do I view a social services authorization in ProviderOne?

Providers will receive an alert message when a social services authorization has been created or changed. To view the social services authorization from the provider portal: 

1. Select Social Services View Authorization List. The Provider Authorization List Page will appear. 2. Enter the authorization number from the alert or search by the Client ID. 

For questions about the authorization, contact the case manager listed on the alert.

Monaural or binaural hearing aids 

The administration covers new, non-refurbished, monaural or binaural hearing aids, which includes the ear mold and batteries, for clients eligible for the service. In order for the provider to receive payment, the hearing aid must meet the client's specific hearing needs necessary as a result of the individual’s disability and be under warranty for a minimum of one year. 

Replacement 

The administration pays for the following replacements when approved with a social services authorization: 

• Hearing aids, which includes the ear mold, when all warranties are expired and the hearing aids are one of the following: 
• Lost 
• Beyond repair 
• Not sufficient for the client's hearing loss 
• Ear molds when the client's existing ear mold is damaged or no longer fits the client's ear. 
• Batteries with a valid prescription from an audiologist. 

Repair 

The administration pays for repair when approved with a social services authorization. To receive payment, all the following must be met: 

• All warranties are expired. 
• The repair is under warranty for a minimum of 90 days.

Rental 

The administration pays for a rental hearing aid for up to two months while the client's own hearing aid is being repaired. In the case of a rental hearing aid, the agency pays separately for an ear mold.