Giv’s Integrated Billing allows you to submit Medicaid claims directly to an integrated payer through Giv. Before submitting claims, make sure the information needed to create and process those claims is set up correctly.
Review your client profiles, budgets, billing codes, staff information, and service records to make sure all required information is complete and accurate. The sections below walk through what to review in each area.
Once everything is set up and you’ve confirmed your billing information is accurate, see Submitting Claims with Integrated Billing for instructions on creating, reviewing, and submitting a billing batch.
Getting Started: Work with your Giv Account Manager to set up your billing integration. Once the integration is configured, you can begin preparing your agency's billing information.
Preparing Client Profiles
Before billing, confirm that each client's profile has all required information. You can use a client you've successfully billed as a reference when setting up other clients.
Basic Info
In the client's Basic Info tab, confirm the following fields are completed:
First Name
Last Name
Gender
Date of Birth
Address
State Payer ID
Important: The State Payer ID should match the client's Medicaid ID when the Medicaid ID is used as the state payer identifier. This information is sent to the payer as part of the claim, so it must be entered correctly.
Health
In the client's Health tab, confirm the following fields are completed:
Signature Indicator
Release of Information
Benefits Assignment
Plan Participation Code
For these fields, enter Yes where applicable. The Plan Participation Code should be set to Assigned.
Diagnosis Code
Confirm that a Diagnosis Code has been entered on the client's profile. A diagnosis code is required for billing.
Preparing Client Budgets
Each client must have a budget configured correctly for the services being billed.
To review a client's budget:
Click Clients in the left menu
Search for and select the client
Click Budget in the slide-out menu
Select the budget you want to review
Confirm the following fields are set correctly:
Service Code
Payer
Billing Integration Payer
Both the Payer and Billing Integration Payer must be configured correctly. Select the appropriate Billing Integration Payer for every budget you intend to bill through Giv.
Also confirm that the following budget information is accurate:
Available Units
Start Date
End Date
Make sure the budget dates cover the service records you intend to bill and that sufficient units are available.
Preparing Staff
Staff members must have the information required by the integrated payer before their services can be submitted.
Confirm that each staff member has the required information, including:
First and last name
Address
SSN
Rendering Provider NPI, where required
The required information may vary depending on the payer and the services being billed.
Preparing Service Records
Service records must be created before they can be included in a billing batch. Service records can be created from completed shifts or entered manually.
Before billing, review the service records you intend to submit and confirm they contain the correct:
Client
Caregiver
Billing/Service Code
Payer
Units
Billing Start Time
Billing End Time
Make sure the service record information matches the client's budget and billing code being used.
Summary
Before creating a batch, review each area above and make sure your billing information is complete and accurate.
Clients
First and last name are correct
Address is complete
Gender and date of birth are entered
State Payer ID/Medicaid ID is correct
Required Health fields are completed
Diagnosis code is entered
Budgets
Correct client and service code are selected
Correct payer is selected
Billing Integration Payer is selected
Available units are sufficient
Start and end dates are accurate
Staff
Required staff information is complete
Address and SSN are entered
Rendering Provider NPI is entered where required
Service Records
Service records have been created
Client and caregiver are correct
Billing/service code is correct
Units are accurate
Billing start and end times are accurate
Once you've confirmed this information is complete and accurate, you're ready to create and submit a billing batch through Integrated Billing.