At Claimeye, we want you to understand the process that comes with a claim when you see a doctor outside the coverage network. For the process to be a successful one, you should know the terms and the necessary information you will need to submit a claim.

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.

Here it is an illustrated example of a superbill:

 

 

(1) Provider’s contact Info

It should have the provider’s name, their address and contact information so that the insurer can identify the doctor or other healthcare provider.

(2) Provider’s EIN

EIN stands for Employer Identification Number, also called a Federal Tax Identification Number and is issued by the IRS. It could be described as a social security number for businesses and identifies your healthcare provider. If your provider doesn’t have an EIN, they may use their social security number. That will work instead.

(3) Provider’s NPI

The National Provider Identifier 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 since it allows them 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 at the same time for a variety of medical issues. 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 old system: ICD09. If your coding is ICD09, your insurance will reject the claim. ClaimEye checks this coding and corrects errors 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. If this information is missing, the bill will be rejected by your health insurance.