Coverage benefits are the big issue for Pediatric practices. Our team is well versed with whats generally covered and whats not and we let our pediatric providers know promptly. Following are examples the coverage & benefit issues-
Billing correct combination of Vaccination/Immunization & their administration codes is an essential part of pediatric billing. Mapping correct ICD code & putting the appropriate modifiers is must to get the payment. We are well informed of addition, deletion of CPT & ICD codes. We also check if any of the code picked by the provider is appropriate for child’s age.
Most of the policies that are HMOs, require subscribers to update the Coordination of Benefits every year-pending which payments may be delayed.
Some policies require servicing provider should be assigned as PCP in their records and if thats not done it results in denial. Once the claim is denied, cannot be reprocessed as Insurance do not update the PCP information retroactively.
If we were unable to get the information at the time of service we notify parents by sending them specific notices, or calling to sort out the matter as soon as possible.
Have InfiCare Services take care for your billing!