What I Need to Know
Clean Claim

Since the company I work for is nationwide and we deal with every type of health insurance plan, I keep a BIG binder of “cheat sheets" with special billing information by health carrier. If the billing process is simple, a cheat sheet is not necessary and on the flip side some carriers have more than one cheat sheet: 

  • Carriers that operate in different states, like Blue Cross Blue Shield.
  • Carrier that handles different plan types, United HealthCare handles commercial, Medicare and Medicaid plans so I tend to make one for each plan type. 

It is impossible to remember all of the different ways that a claim must be billed so I refer to these cheat sheets on a daily basis to provide me with special billing information. Special, to me, is any special instructions, required attachments, EDI Submitter numbers, required modifiers, etc.  This way I am confident that I have what I need to submit a clean claim. 

For difficult claims where I've had to bill it more than once before it was paid, I also keep a copy of the claim with the patient info removed so I have an example of how to recreate it the next time.

Health carriers have started to return claims that have billing errors. Review all returned claims for more than just address corrections.

Take the time to read the many health carrier bulletins you receive, they provide “advance warning” about billing changes, new procedures, required modifiers, etc.,  so you can incorporate this information into your billed claims early to avoid rejects.


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