A Guide to Superbills (Part 1)

Here at CLAIMEYE, we want to be certain that all our users understand the process that goes along with claim(s) submission when seeing a doctor/provider outside of your coverage network. The best way to ensure this process is successful and hassle-free, it is important to know what documents and essential information are required prior to submission. Taking these steps will assist you in minimizing clerical errors and common mistakes while decreasing the likelihood that your claim will be returned or rejected and guaranteeing faster reimbursement.

What is a Superbill?

A Superbill is a document that outlines the care a patient has received and, if you have paid out-of-pocket, it contains the important information you will need to get reimbursed from your health insurance company.

When do I get a Superbill?

After paying for your visit with an out-of-network provider you will receive a basic receipt. This basic receipt of payment will not have all the required information. What appears on a Superbill (also referred to as a “coded bill”) is not only the itemized care you received and payment rendered, but the specific medical codes and other pertinent details necessary for your insurance company to process your claim(s). It is important to note that you will most likely need to request a Superbill from your provider.

At CLAIMEYE want you to understand the process that goes along with filing a claim after an out-of-network doctor visit. Our job is to equip you with all terms and necessary information you will need to submit a claim.

Here is an illustrated example:

(1) Provider’s contact information:

You will need to have the provider’s name, address and all other relevant contact information for the insurer to correctly identify the practitioner.

(2) Provider’s EIN:

EIN stands for Employer Identification Number, also referred to as a Federal Tax Identification Number (TIN) and is issued by the IRS. This number is unique, similar to a social security number for businesses and identifies your healthcare provider. Your provider will either provide an EIN, TIN or they may use their social security number.

(3) Provider’s NPI:

The National Provider Identifier (NPI) is a 10-digit identification number supplied by the Centers for Medicare and Medicaid Services (CMS). It has been adopted as the standard provider identifier and most healthcare providers, individual therapists, doctors and entire hospitals are issued one. The NPI allows a practitioner to work within the insurance system. An NPI is optional. If your provider doesn’t have one, that’s okay.

(4) Appointment Date:

A Superbill will show a date for each separate appointment. It can be for a single appointment or many appointments but requires a date for each individual appointment that is being billed for.

(5) Diagnosis Code:

This code is a tool to classify symptoms, diseases, diagnoses, and all other patient interactions. This identifies to the insurer why you are receiving care. In some cases, there will be multiple diagnosis codes if you’re being treated for a variety of medical issues at one time. Every appointment will have a diagnosis code, even if you are not sick. The coding process for diagnostic codes gets updated over time. The current version of International Statistical Classification of Diseases and Related Health Problems is known by the more convenient acronym: ICD10, but many providers are still using the older system: ICD09. If your coding is ICD09, your insurance will reject the claim. CLAIMEYE makes sure to check for this exact coding and corrects these errors for you automatically.

(6) CPT Code

CPT stands for Current Procedural Terminology, a medical coding system, created by the American Medical Association (AMA) to define medical, surgical, and diagnostic procedures. There is a code for each procedure performed, specified by a 5-digit number. These codes and their accuracy are absolutely essential to successful claim(s) submission.