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medical claims billing book __medical claims billing book



Understanding medical claims billing

Medical Claims Billing is the process of submitting medical insurance claims to the proper insurance carrier.  It is important to understand all aspects of medical claims billing in order to make sure you are bringing in all the money that is due to the provider.

     Learn the advantages of billing electronically ,when to file UB04's and HCFA 1500's , and how to file no-fault and  workers' compensation claims .

     Many insurance companies, especially the larger ones, not only prefer claims to be submitted to them electronically, but they are trying to mandate it. For example, in New York, Medicare requires you to get an exemption form if you are still filing your claims on paper and is now even denying secondary claims billed on paper by larger providers.

     If the insurance company does not mandate that the claims be submitted electronically, they offer many great incentives for doing so. In most cases, the incentive is quicker payment of insurance claims. This usually works for most providers.      It does for the doctors that I work with! They want their payment ASAP! Electronic claims are usually paid in half the time that paper claims are paid in. 

Click here for more information on billing your claims electronically.

     Of course there will always be situations in which it is necessary to file the insurance claim on paper.  Many secondary claims must still go on paper in order to attach a copy of the primary insurance company’s EOB (Explanation of Benefits Statement). Or you may have other attachments that must accompany the claim such as treatment notes, or an operative report.

     Then there are those smaller insurance companies that are still not able to accept electronic insurance claims. In these cases you will most likely use
HCFA 1500  forms.

     If you are considered an institution you will most likely be required to file your claims on a  UB04 form, which is specific to facility billing.

     When the services are related to a workers’ compensation injury, you will need to fill out a  C4 Form

     In most cases you will be doing a combination of all of the above methods of sending claims when doing medical claims billing. Therefore, you will need to familiarize yourself with all of them.


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