2/18/2013
1) Ask for a copy of each patient’s insurance ID card on every visit.
Midlands Choice often receives claims with group and payer information that is no longer accurate or for groups who no longer have a relationship with Midlands Choice. Entering current data not only prevents a HIPAA violation, but can also improve claim payment turnaround time. It is also important to place the name of the insurance carrier, not Midlands Choice, in the payer name field. Unless you are treating a Midlands Choice employee, box 11b and 11c should be populated with the name of the patient’s employer group and the name of the insurance carrier.
2) Review your claims for 5010 compliance prior to submitting them.
While the numbers are improving, Midlands Choice still receives more than 3000 claims each month that are not 5010 compliant. For assistance in submitting claims correctly, review the Claim Submission Guidelines article on www.midlandschoice.com.
3) Put physicians’ names where they belong.
A growing number of EDI claims are being submitted with physicians’ names entered where only organization names should appear. While it may seem easier to put a provider’s name in a single field rather than to break it into the appropriate separated fields (i.e. Last Name, First Name, Middle Initial and Credentials), if the name is not entered correctly the claim will be stopped for manual review at Midlands Choice and may potentially be rejected by the payer.
4) Have you moved? Changed your name? Does Midlands Choice know about it?
When you move, add a location or change your name, Midlands Choice requires advanced notice of the change. If you bill using information that Midlands Choice does not have on file, your claims will be considered non-participating. To avoid this, please notify Midlands Choice of your new information 6 to 8 weeks in advance of the change. You can easily submit address changes or add network providers to your location by using our online demographic update form. If you wish to only update a provider’s name, degree and/or specialty, email the Midlands Choice credentialing department. Be sure to include the effective date of the change.
5) NPI does not eliminate the need to submit the rendering physician’s name.
Midlands Choice has received claims for office visits that are being billed with no rendering physician name in box 31, but with an NPI in 24J. Because payers require a rendering physician’s name, these claims are often rejected. Save yourself a resubmission by including the name on the claim the first time.