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How do I fill this out?
Filling out the DMAS forms correctly is crucial for the submission process. This section will provide you with a step-by-step guide to ensure accuracy and completeness. Carefully follow the instructions to avoid any issues.

How to fill out the DMAS Billing Forms Information and Instructions?
1
Request the required DMAS forms by calling or faxing.
2
Ensure you have a street address for delivery.
3
Limit your order to a two-month supply.
4
Fill out the forms without making photographic copies.
5
Submit the completed forms to the appropriate address.
Who needs the DMAS Billing Forms Information and Instructions?
1
Healthcare providers who need to submit claims for pharmacy services.
2
Pharmaceutical companies submitting compound pharmacy claims.
3
Billing departments handling Title 18 invoices and adjustments.
4
Providers without Internet access to download forms from the DMAS website.
5
Medical professionals managing Medicaid or Medicare billing.
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1
Upload your PDF file to PrintFriendly.
2
Use the editor to complete the necessary fields.
3
Make any additional adjustments or corrections.
4
Save your edited document.
5
Download the final version of the PDF for submission.

What are the instructions for submitting this form?
To submit your completed DMAS forms, you may fax them to (804) 780-0198 or mail them to the designated DMAS mailing address provided in your instructions. Ensure all submissions adhere to the guidelines and include a street address for delivery if applicable.
What are the important dates for this form in 2024 and 2025?
Ensure all forms are submitted timely. Key dates for 2024 and 2025 will depend on your specific billing cycles and DMAS deadlines.

What is the purpose of this form?
This document provides critical information about various DMAS billing forms. These include Title 18 invoices, adjustment invoices, and pharmacy claim forms. Proper understanding and use of these forms ensure accurate billing and prompt reimbursement.

Tell me about this form and its components and fields line-by-line.

- 1. DMAS 30 R 6/03: Title 18 Invoices for billing.
- 2. DMAS 31 R 6/96: Title 18 Adjustment Invoices.
- 3. DMAS 173 R 6/03: Pharmacy Claim Form.
- 4. DMAS 174 R 6/03: Compound Pharmacy Claim Form.
What happens if I fail to submit this form?
Failure to submit the DMAS forms accurately and on time may result in delays or denial of claims. Ensure all fields are correctly filled and forms are submitted by the deadlines.
- Delayed Reimbursement: Claims may be delayed or denied if forms are not submitted correctly.
- Inaccurate Billing: Incorrectly filled forms result in inaccurate billing and possible rejections.
- Administrative Issues: Failing to follow submission guidelines can lead to administrative complications and additional paperwork.
How do I know when to use this form?

- 1. Medicaid Claims: Submitting claims for Medicaid services.
- 2. Medicare Claims: Submitting Title 18 invoices and adjustments.
- 3. Pharmacy Claims: Submitting pharmacy and compound pharmacy claim forms.
- 4. Billing Adjustments: Submitting adjustments to previously submitted invoices.
Frequently Asked Questions
How do I request DMAS forms?
You can request DMAS forms by calling the DMAS Order Desk at (804) 780-0076 or by faxing your request to (804) 780-0198.
Can I submit photographic copies of the forms?
No, photographic copies cannot be submitted as they do not scan properly. Use the original forms provided.
Where can I find DMAS forms?
DMAS forms are available on the DMAS website or in each provider manual. For providers without Internet access, forms can be requested by calling Commonwealth-Martin at 804-780-0076.
Are bulk quantities of forms available?
Bulk quantities cannot be sent to a P.O. Box. Requests must include a street address and be limited to a two-month supply.
How do I fill out the forms?
Follow the detailed steps provided in this file to complete the forms accurately.
What should I do if I need a specific form?
You will be sent one original form for each requested form. Use this original for photographic copying and submission to DMAS.
How do I edit DMAS forms on PrintFriendly?
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Can I sign DMAS forms on PrintFriendly?
Yes, you can add your signature to DMAS forms using PrintFriendly's editor.
How do I share DMAS forms using PrintFriendly?
Upload your PDF, complete any edits, and share the document via email or download it for further distribution.
What if I have trouble accessing the DMAS website?
Providers without Internet access can call Commonwealth-Martin at 804-780-0076 to request forms.
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