Dirty Claims? Clean them up with our optometry billing service!

Most practice management systems offer the convenience of submitting claims with one click. However, it’s important to verify the accuracy of information on your claims prior to submission. Coding errors, incorrect member ID numbers, or missing information can result in claim denials that create additional work and also cause a delay in reimbursement.

Before sending a batch of claims to your clearinghouse, be sure to “scrub” the claims to ensure they don’t contain any errors that might cause them to reject or deny. Some items to check for include:

· Demographic information - does the name and ID number on the claim match information shown on the insurance card?

· Patient signature on file and accept assignment fields - make sure boxes 12, 13, and 27 of the CMS1500 form are completed correctly so that payment will be sent directly to the provider.

· Referring provider information - some services such as co-management and diagnostic testing require the name and NPI of the referring provider in Boxes 17 and 17a.

· Prior authorization number or CLIA number in Box 23 if required

· Correct coding - make sure the diagnosis pointers for each line item correspond with the CPT code billed, add any necessary modifiers.

· Include any other pertinent information in Box 19 - Such as assumed and relinquished care dates for co-management claims.

· NPI number of rendering provider in Box 24 - Some states also require provider taxonomy codes for Medicaid claims.

· Payer ID - be sure this is set up correctly in your PMS so claims will go to the right place!

While the majority of insurance companies share standard claim requirements, it’s a good idea to become familiar with the rules of submission for each payer you bill.