Insurance policies make it easier for everyone to afford their medical bills during emergencies. It’s always great to have one until you found out you need to go through the process of submitting insurance claims.
For claims processing to be successful, it needs to have steady and proper communication between you, your healthcare provider, and your insurance provider. To some, it’s an excruciatingly long process. But for others who know a thing or two on how to submit a claim properly, it can be more manageable.
Options For Submitting Insurance Claims
Processing insurance claims for medical billings used to be a bother. Luckily, there are two ways of submitting health insurance claims:
- Healthcare services that offer direct transactions to insurance providers/payers.
- You fill up the forms and submit claims to the insurance provider yourself.
The pros of having your healthcare provider do it for you are mostly convenience. You don’t have to worry about filling up forms and running papers around since they can do the work for you. However, some healthcare providers also struggle when submitting insurance claims. When papers and billings get piled up, and there’s no steady process in place, your insurance claim can get denied constantly. Worst, you’ll have to wait for the reprocessing to finish for months (even years).
While receiving a notice that your claim is denied can be alarming, know that it can still be revised and resubmitted. If you can’t entrust this process to your provider, or you need to speed things up, try doing the processing yourself. It takes a few basic steps to submit a claim if you’ve already paid out-of-pocket.
4 Steps To Submit A Claim
Submitting claims to insurance is a tough thing to handle. But if you have a good knowledge of how it’s done, and what you should prepare for, it can help lighten the load.
Here are the 4 basic steps you should know when submitting insurance claims:
Step 1 – Ask for an itemized receipt from your doctor/ healthcare service
Start with obtaining a list of items detailed in your receipt. Contact your doctor or your healthcare provider and ask for this. It should have all healthcare services provided, professional fees, and the costs of each. It should also have all the medications, treatments, and laboratory costs included in the list.
This part should be easy, all you need is to call your provider and tell them you need it for your insurance claim. Once received, double-check everything with your doctor/provider to make sure nothing is amiss.
Step 2 – Get your claim form from your insurance company
The next step is to ask your insurance provider for their claim form. If you haven’t processed a claim for a long time, there might be differences in the form provided by your insurance. So make sure you got the most updated form to avoid any delay.
This form is different with every insurance provider. This is because they also have different rules, metrics, and indicators depending on the policy they are offering. The more information you put on the form, the more it’s helpful for everyone. Also, make sure you understood the instructions and keep your details consistent with your account details. Some of these details would be:
- Your basic personal information (Name, Address, Date of Birth, etc.)
- Insurance policy details and account/subscriber number
- Reason for a medical visit, and other details about your illness and conditions
- Information of your healthcare provider, and doctor’s name
- All the expenses that you already paid
Step 3 – Make a copy of it (at least 1)
This is an important step that most people miss. Keep in mind that these documents involve three parties: you, your healthcare provider, and your insurance provider. You should make a copy of all the documents you have received from them to eliminate mistakes during medical claims processing.
If you know a thing or two about medical codes, you can also check for inconsistencies and ask your provider if there’s something that needs to be addressed. Make sure all the services, medications, and treatments are reflected in the codes.
Step 4 – Review carefully then send
Review everything before sending it to your insurance provider. Your aim is to achieve a clean claim for your claims submission. Call your insurance to let them know about your claims submission.
Next is to submit all paperwork to your insurance provider. If possible, you can email or fax them these papers to speed things up. Take note that it can take up to 30-45 business days of processing your claim– you don’t want to mess this up and wait another 45 days. However, some providers have different timelines. It’s best to ask them via a call to know how long you need to wait.
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In comparison, it’s much easier and less of a hassle if your chosen healthcare provider does all the submission for you. However, it’s important to know that claims processing is a lot more complex from their point of view. Some of the steps above are also dependent on your healthcare provider’s skill in processing and coordination, especially on the consistency of your medical bills and records.
Healthcare providers need to have a steady system when it comes to claims processing and submission. As pros in the field, we at MedCal Group offer all the medical billing outsourcing help you’ll ever need for it. If you’re interested to know more, give us a call.
References:
https://www.internationalstudentinsurance.com/explained/claims-submission-in-detail.php
https://www.thebalance.com/if-you-have-to-file-a-health-insurance-claim-form-2645672
Last updated on 2022/07/18 | Posted on 2022/07/06