BILLINGRESOURCEMANUAL
December2013
PublicHealthBillingResourceManualDecember2013
PREFACE
ThePublicHealthBillingResourceManualprovidespolicyproceduralguidanceon
howtobill3rdpartypayersforpublichealthprogramsandservices.Developedasabilling
resourcetool;itspurposeistoassiststate,districtandcountypublichealthstaffin
understandingtheinsurancecodingandbillingprocess.
PartI-ThePoliciesandProceduressectionfocusesonthetermsandconditionsofbilling
andreimbursementfrom3rdpartypayers.Itprovidesguidanceoneligibilityverification,
coordinationofbenefitsandbillingprocedurestoavoiddelaysinreimbursement.
PartII-TheBillingCoding:MethodologiesRatessectionemphasizestheimportance
oftheclinicalcomponentsofCPTcodingtoensure3rdpartypayersarechargedatthe
appropriatelevelofservicedeliveryandreimbursement.
TheAppendicessectionincludesRelatedLinks,BillingContactInformation,Acronyms,
Definitions,andotherresourcesusedinmasteringthereimbursementprocess.
Amendmentsaremadequarterlyinaccordancewithpolicychangesinfederalandstate
laws.
Disclaimer:ContractProvisionsbetweenDPHand3rdPartyPrivatePayerscontain
confidentialandproprietaryinformationthatprohibitsdissemination,distributionor
disclosureofreimbursementratestoanypartiesotherthancountyBoardsofHealthand
DPHemployees.ThesereimbursementratesaredispersedtoappropriateDPHstaff
throughtheDepartmentemailsystem.
Currently,GeorgiaDPHiscontractedwiththefollowing3rdPartyPayersforImmunization
Services:
MedicaidFee-Fo