May3resources

PDF of May 3rd, 2014 presentation 05-03-14 Lynne Coon Presentation

What you need to apply to insurance panels:

Some insurance companies will accept CAQH and others will require the Oregon Practitioner Credentialing Application. You have to first apply to an insurance company and they will assign a CAQH number to you. After that you can apply to any panel who accepts the CAQH with that number.

           Council for Affordable Quality Healthcare (CAQH): https://upd.caqh.org/oas/

           Oregon Practitioner Credentialing Application: http://www.oregon.gov/oha/OHPR/ACPCI/docs/2012/2012credappglossary.pdf 

You should have a National Plan & Provider Enumeration System (NPI) number assigned by whoever you did your internship with, if the site billed for your services. You can find out whether you’ve been assigned one and what that number is through the link below:

           NPI: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions

It is better to use an Employee Identification Number (EIN) for billing rather than your Social Security Number. Applying for one is quick and free:

          EIN: http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/How-to-Apply-for-an-EIN

 

List of Insurance Providers & Employee Assistance Programs (EAP):

Insurance company list (Excel): Insurance Panels

Insurance company list (PDF): Insurance Panels

Employee Assistance Program list (Excel): Employee Asst Prgm list

Employee Assistance Program list (PDF): Employee Asst Prgm list

 

More information on medical necessity

      Medical Necessity

 

Coordinating care documents:

Word: Coordination of care form

PDF: Coordination of care form

 

Paperwork for insurance:

Left side of file forms should include:

Information Sheet

Billing Authorization  (Word document)

Billing Authorization  (PDF)

Diagnostic Summary

Right side of file has progress notes

 

Electronic Billing Options

These are the more popular ones:

www.officeally.com (free)

http://www.availity.com/ (free) right now they have a limited number of insurance companies they’re working with

www.therapyappointment.com ($57.50/month)

www.therapynotes.com ($59.95/month)

www.therabill.com ($80/month)

For a review of more options and more detail on prices plus pros and cons of electronic filing software:
http://www.tameyourpractice.com/blog/cloud-practice-management-system-reviews

 

Super Bill for out of network clients

Generic Superbill  (Word)

Generic Superbill  (PDF)

 

Medicare denial letter

A document explaining the process of getting a denial letter: For_Denial_Only_final_acro

Samples of Medicare letter I wrote:

Medicare Denial Ltr Request  (Word)

Medicare Denial Ltr Request  (PDF)

 

To solve insurance problems or find answers to your questions:

Barbara Griswold   navigatingtheinsurancemaze.com
Book: Navigating the Insurance Maze (see the flyer for her new book: Book Flier April 2014)
Newsletter (updates) www.navigatingtheinsurancemaze.com/articles.htm

Fran Wickner   franwickner.com/?page_id=540

Deb Legge, PhD    influentialtherapist.com/influential-therapist/blog/