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Mental Health Providers Claims Data

Mental health providers needing Medicaid claims payment data to complete their cost reports should complete the Provider Mental Health Claims Data Request Form.

HP Enterprise Service [EDS] will be able to generate the data for each unique Medicaid provider number for claims adjudicated within the past 24 months.

For those services billed through the LME, HP Enterprise Service [EDS] will not be able to extract the data based upon the attending provider number. The provider will need to contact the LME for their claims data report.

• Provider Mental Health Claims Data Request Form (9 KB Adobe PDF)
• Provider Mental Health Claims Data Request Form (21 KB Microsoft Excel)