Glossary

Medicaid doula billing glossary

Definitions for terms used in Medicaid billing rules, payer instructions, and claim checks.

Terms

Each term includes its billing meaning and related requirements.

NPI

An NPI is a national provider number used on healthcare claims and payer enrollment records. Some doula Medicaid programs require an individual NPI, a group NPI, or both.

ProviderOne

ProviderOne is Washington's Medicaid provider and billing system. Washington doulas use it for provider setup and fee-for-service claim entry.

Fee schedule

A fee schedule is a payer table that lists codes, rates, and sometimes modifiers or effective dates. It helps show what a state says it pays before payer review.

Managed care / MCO

Managed care means a Medicaid health plan handles some or all coverage and billing steps for a member. MCO stands for managed care organization.

Fee-for-service

Fee-for-service is a Medicaid payment path where the state Medicaid program pays claims directly instead of routing them through a managed care plan.

837P

An 837P is the professional healthcare claim format used by many billing systems and clearinghouses. Doulas may see it when a biller or software prepares a professional claim.

CPT

CPT codes are medical procedure codes used on claims and fee schedules. Some state doula guides use CPT-style codes or state-specific billing rows.

HCPCS

HCPCS codes are healthcare billing codes often used for Medicaid services, supplies, and state benefit rows. Many doula programs use HCPCS codes such as T1032 or T1033.

Modifier

A modifier is added to a billing code to describe a specific service, setting, or program rule. Examples include state-specific modifiers for doula visit type or delivery support.

Timely filing

Timely filing is the deadline for sending a claim or corrected claim to the payer. The deadline can vary by state, payer, plan, and claim type.

Unit-based billing

Unit-based billing means payment is calculated from billing units, often 15-minute time blocks. The state may set a unit rate and a maximum number of units.

Units

Units are the quantity billed for a service line. For timed doula services, one unit is often a set number of minutes, such as 15 minutes.

Prior authorization

Prior authorization is payer approval before a service, extra visit, or exception is billed. Some states use a different term, such as prior approval.

Provider enrollment

Provider enrollment is the process of being approved by Medicaid or a Medicaid plan before billing. It can include IDs, attestations, portal setup, and state-specific documents.

Provider type code

Some NPI and payer enrollment records use provider type code 374J00000X for doulas. Check the state Medicaid program or health plan before enrollment.

Clean claim

A clean claim has the required provider, member, service, code, modifier, documentation, and timing details needed for payer review.

EOB

An EOB, or explanation of benefits, explains how a payer processed a claim. It can show paid, denied, adjusted, or patient-responsibility details.

EVV

EVV means electronic visit verification. It is a system some Medicaid services use to verify visit details electronically.

TPL

TPL means third-party liability. It refers to another insurer or responsible party that Medicaid may need considered before payment.

NCCI

NCCI is a federal coding-edit program that helps payers identify code combinations that should not be paid together or need special handling.

Eligibility verification

Eligibility verification means checking that the client has active Medicaid coverage for the relevant date and payer path. It should happen outside public tools.

Burnout is a stress response that can show up as exhaustion, dread, numbness, cynicism, or feeling less able to recover. In doula work, it can build when emotional labor, on-call time, hard births, and administrative pressure outpace support.

Vicarious trauma

Vicarious trauma means changes in how someone feels, trusts, or sees the world after witnessing or hearing about trauma. Doulas may notice it after repeated exposure to hard births, loss, disrespect, racism, or medical stress.

Secondary traumatic stress

Secondary traumatic stress describes stress symptoms that can come from being close to someone else's trauma, including intrusive thoughts, sleep trouble, avoidance, numbness, or feeling on edge.

Compassion fatigue

Compassion fatigue describes feeling worn down by repeated caring work. A doula may still care deeply while feeling emotionally depleted, numb, irritable, or less able to be present.