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What You Need From Your Patient to Bill Insurance

Success in insurance billing relies heavily on good communication between you and your patient. We’ve put together a list of all of the information that you should collect from your patient so that you have the best chance at clean claims processing when it comes time to bill for their session.

What Information to Collect

Patient Name

Make sure that the name of the patient that you have in your system matches the patient’s name that is listed on the insurance card. Be sure to confirm the proper spelling of the patient’s name as it would appear in the insurance system.

Name of the Insurance Plan Holder and Relationship to Insured

If your patient is on a parent or spouse’s insurance plan, make sure to get their name as well with proper spelling. Identify the relationship of the insured person to your patient (ie; father, mother, spouse, etc.)

Patient Date of Birth and Date of Birth of Insured

You will need the date of birth of your patient, as well as the date of birth of the person whose insurance plan will be billed. Many times this is the patient, however it could also be the date of birth of a parent, spouse, or legal guardian.

Patient Address

Make sure that you have an updated address for your patient and that you collect all necessary information.

Name of Insurance Provider

The insurance card should include the name of the insurance company that claims should be sent to. Make sure that you properly identify the insurance company so that claims are submitted to the proper place. The back of the insurance card should also have an address for the insurance company that claims should be directed to.

Name of Secondary Insurance Provider (If Applicable)

Confirm with your patient or your patient’s parents whether they have a secondary insurance plan. If the patient is covered under two different insurance plans, you will need to ask the patient which is primary and which is secondary so that claims can be submitted properly according to the Coordination of Benefits.

Copy of the Patient’s Insurance Card

Most of the information that you need to collect can be found on the patient’s insurance card. If you collect the information from the patient as well as collect a copy of their actual card, it can be a helpful reference if you run into claim submission issues later on. You will be able to reference the exact card that was provided to you, look for any discrepancies, and easily check whether or not a patient has a new insurance card on returning visits by comparing their current card to the card you have on file. Be sure to make a copy of both the front and back of the card.

HIPAA Consent Form

You should have all patients sign a HIPAA Consent Form in order to submit a claim for their session. This form should inform the patient that their protected health information may be shared with a third party clearinghouse in order for an insurance claim to process. For more information on HIPAA compliance, read our blog post HIPAA and What You NEED to Know.

When to Collect the Information

Some of this information can actually be collected from the patient before they even enter your office. The use of an online patient portal can make the process seamless for both you and your patients. As soon as you have a new patient, you can send them their online portal information and have the patient fill out the appropriate forms to return back to you. You can then use the information to perform an eligibility check (or have your Practice Solutions Biller complete the eligibility check for you) with their insurance provider prior to them arriving for their session.

If you do not have a patient portal setup, you or your office admin could collect all of the necessary information from your patient over the phone, or via secure email prior to the appointment.

You can also collect any of this information from the patient when they arrive for their initial appointment in the office. Collecting information on the day of the session provides adequate time for claim submission, however that does not allow time for an eligibility check prior to the patient’s appointment. This can be important for patients who are concerned about costs.

Updating Patient Information

Making sure that your patient records are up to date is important for insurance billing. It is important to check frequently if a patient’s address is still current, and also that the insurance that you have on file is current. Any changes need to be updated in your system as soon as possible to make sure that claims are submitted with the proper information.

Resolving Issues in Patient Information

Patients may inadvertently give you information that may not match what the insurance company has on file, which can cause issues in claims processing. This is why collecting the insurance card is so important, because the insurance card can give you a point of reference in resolving any claims processing issues. Verify all information that a patient has given you against their card, and if everything matches you can use phone numbers listed on the back of the insurance card to get in touch with the insurance company to learn more about the issue. Practice Solutions Billing Specialists are skilled at aiding in resolving claim issues surrounding patient information. If you are experiencing challenges in insurance billing, reach out to us today to learn more about our billing services and how we can help.

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