MDHHS Provider Relations Training Survey Question Title * 1. What is Your Name? Question Title * 2. What is Your NPI? Question Title * 3. What Claim Form do you Bill on? UB-04 CMS 1500 Dental Question Title * 4. What is your Provider Specialty? Ambulance Clinics: Rural Health Care (RHC), Federally Qualified Heath Centers (FQHC), Local Health Department (LHC) or Total Health Care (THC) Dental Nursing Facility Inpatient Hospital Outpatient Hospital Home Health, Hospice or Private Duty Nursing (PDN) Behavioral Health Vision Other Professional: CMS 1500 Billers Other Institutional: UB-04 Billers Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) General Family Practice Maternal Infant Health Program (MIHP) Family Planning Laboratory Ambulatory Surgical Center (ASC) Question Title * 5. What Types of Training are you interested in? Automated Billing/EDI Behavioral Health Services Beneficiary Eligibility CHAMPS Navigation Children Special Healthcare Services (CSHCS) Coordination of Benefits Document Management Portal (DMP) How to Adjust or Void a Claim ICD-10 Level of Care Medicaid Code Rate and Reference Medicare Buy-In Predictive Modeling Provider Enrollment Spend Down Third Party Liability/Other Insurance Timely Filing Policy When to Bill a Beneficiary Other (please specify) Next