Provider Information

Welcome! As a valued provider, DIHS is committed to providing you with the information and tools you need to provide service to individuals in the custody of the Immigration and Customs Enforcement.

Standard Reimbursement to Providers:

Providers are reimbursed the lesser of Medicare or Billed Charges in accordance with Title 18, Part 3, Chapter 301, Section 4006 of US Code for authorized services.

Authorized Services:

All services require an authorization from the Division of Immigration Health Services (DIHS).

• Treatment Authorization Requests (TARs) are submitted directly from the custodial facility to DIHS.
• DIHS returns the TAR to the custodial facility and denotes the authorized services.
• A copy of the TAR should be provided to you by the custodial facility.
• Payment for authorized health services is subject to custody verification.
• All health services are subject to retrospective review.
• For all non-emergency authorized health services the TAR is valid for 45 days after the date of issue and cannot be used for health services rendered prior to the date of issue.
• For emergency authorized health services the TAR is valid for 7 days prior to the TAR date of issue.
• In an emergency, the Health Service Provider shall provide the medical treatment required to preserve the detainee's health. The Detention Facility shall notify the MCC on the next business day and submit a TAR to obtain authorization.
• The Detention Facility shall also obtain authorization from the MCC for continued medical service(s) beyond the initial emergency situation. The Detention Facility shall provide Health Service Providers instructions for submitting claims.

If you have questions regarding what services are authorized, please contact the referring custodial facility or contact the appropriate DIHS' Managed Care Coordinator (MCC) and provide him/her with the Authorization Number.

Only authorized services will be reimbursed.

Treatment Authorizations Category Definitions:

• Consult Only - Consultative health services only that are consistent with the consultative Provider's specialty and detainee's medical condition as listed on the TAR.
• Emergency Room - Health services consistent with an emergency room setting and detainee's specified medical condition as listed on the TAR. In cases where an inpatient admission may be medically necessary following an initial emergency room visit; a new TAR must be submitted by the detainee's custodial facility.
• Medical Appointment (Not a consult) - Health services consistent with the provider's specialty and detainee's specified medical condition as listed on the TAR.
• Medical Lab/Test - Labs and/or tests consistent with the detainee's specified medical condition as listed on the TAR.
• Inpatient Hospitalization - Health services consistent with an inpatient hospitalization and the detainee's specified medical condition as listed on the TAR.
• Dental Services - Health services consistent with a dental Provider's specialty and detainee's specified medical condition as listed on the TAR.
• Non-Formulary Medications - Any medication not included on DIHS' designated formulary.

Claims:

• The Health Service Provider shall submit claims using the appropriate form. Samples of the forms are available at Managed Care Forms.
  • CMS-1500 - Medical Services
  • CMS-1450 - Institutional Services
  • ADA - Dental Services
• The Health Service Provider shall ensure that all claims associated with detainee medical services are submitted to DIHS by mailing claims to the following address with a copy of the TAR:
  Division of Immigration Health Services
  VA Financial Services Center
  PO Box 149345
  Austin, TX 78714-9345
  800-479-0523