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Another Question Answered! Tip

How to make sure your medical claim is correct before you send it out to the insurance company.

I have a rule never send any claims out before you review them. It saves the office from deniels, or it will not go out if the claim has anything about the patient or their insurance incorrect. Since we are busy all day we just want to submit the claim. I say don”t.

  1. Medical Billing Is New to your team.
  2. All billing can have a simple error like no zero in the correct box.
  3. It will not get paid faster it will just delay payment or cause it to be denied.
  4. This is my checklist and I have been coding for years, but change and information is never just when new codes come out but when patients policy made changes you don’t know about or the patient is not listed on the plan.
  5. This is my list feel free to utilize this and keep me posted on how it worked for you!

First Call with Patient

  • Gather patient information on phone and have them fax or email list of
    medications
  • Copy of medical card front and back (have them email or fax)
  • Release form from medical provider (see form page?)
  • Confirmation of Medical Benefits/Eligibility (see form page?)
    After patient visit
  • Pre-authorization
  • All CT Scans need Preauthorization
  • Have a list of codes ready to bill after first visit ( only call for verification after you
    have your codes in order)
  • Completed clinical SOAP notes
  • Completed clinical/radiographic evaluation
  • Diagnosis and procedure codes from provider
  • Ask insurance what they need to complete the process, don’t send unless they ask
  • Ask if you can fax in and give date treatment is to be completed
  • If it is an ongoing case ask how to keep it open until completed.
    Claim preparation
  • Pre-authorization for surgery received/add to claim
  • Scrub claim/ go over all modifiers/qualifiers make sure you have referring doctor
    with NPI
  • If you are attaching a Letter of Medical Necessity, add see letter in box 19 or write in
    box 19 short narrative.
    Clean Claim
  • Referring doctor noted in box 17, with NPI in 17b
  • Attachments noted in box 19
  • Lab charge in box20f trauma make sure section 21 has dates
  • Lab name and NPI noted in box 32/32a
  • WHEN USING ELECTRONIC BILLING LOOK FOR VERIFICATION SO YOU KNOW
    ALL IS FILLED OUT
  • IF YOU USE FIND A CODE LEARN HOW TO USE THE SCRUB FOR CLAIMS

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