What I Need to Know
PPO

Always call the health carrier to obtain benefit information so that you can set you expectations for patients upfront cost and always collect that amount at the time of service.

There is no way to bill a claim as “in network” or “out of network.” Nothing in the way a claim is coded or billed will put the claim on the correct path for processing. That part of the magic is suppose to happen when the claim is processed by the health carrier. This means that you will create your claim as normal but the health carrier must have linked the NPI to pay either pay in network or out of network.

A lot of times incorrect payments are made so be sure to review all EOB's and dispute all incorrect payments.


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