This intel on filing medical billing claims is intended to help medical billing professionals and is not intended for patients or the general public. Filing electronic medical claims does not always solve problems with the claim sometimes it actually causes more payment delays if the information is not interpreted correctly.
Due to the HIPPA law all claims are to be filed electronically. That's the law. The claims must be ready to accept electronic codes. We don't have to participate with the provider's insurance but we do need a provider number and a pin number for the provider. We also have to maintain insurance carrier codes. So we are constantly on the lookout for new carrier payer id numbers which are constantly being added. Sometimes electronic claims get rejected at the clearinghouse because they don't have the right payer number.
Sometimes you must say to the insurance carrier well you send us letters requesting that we file the medical claims electronically and then they say that they can't find our claim. You have to tell them in a letter or by phone that this claim was submitted on 4/10/10 for $2,000 electronically and the claim was submitted correctly.
This is an example of an appeals letter for timely filing.
In regards to: ID# 129607112402
Ronald R. Marone, M.D.
P.O. Box 200
Massapequa Park, NY 11762
United Healthcare
P.O. Box 1600
Kingston, NY 12402
Dear United Healthcare:
Subject: Ms. Josette Mayer
Acct# B7 0369
Date of Service: 2/17/10
This claim was originally filed 3/17/10 to Heritage electronically via N.E.I.C. We understand that you have denied this claim for untimely filing. We attach and submit proof of timely filing and would like to submit this claim for your review for payment to the anesthesiologist.
Thank you for your consideration in advance,
Lisa Manuto
Here are some sample medical billing claims addresses and contact information.
Chickering Insurance Company
P.O. Box 15708
Boston, MA 02215
Phone: 800-859-8471
American Medical Security
P.O. Box 19032
Green Bay, WI 54307
Phone: 800-232-5432
Gary Porter 800-232-5432 ext. 71825
Extended Benefits
Waldwick, NJ
Phone: 800-333-9836
Horizon Healthcare of New York
Phone: 800-624-1110
Independent Processing
18 Heyward Street
Brooklyn, NY 11211
Crossroads Healthcare
P.O. Box 090540
Staten Island, NY 10309
Ace International Medical Claims
P.O. Box 15417
Wilmington, DE 19850
Phone: 302-476-6187
Allstate
888 Veterans Memorial Highway, Suite 300
Hauppauge, NY 11788
Qualcare
P.O. Box 249
Piscataway, NJ 08855
Phone: 800-992-6613
Contact: Gary Epsilon
Direct Line 732-562-2096
Fax the claim to 732-562-1070
Fax the claim and then send a corrected claim via the mail to ensure the carrier got the claim because Gary might not handle that account and so on.
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Contributor's Note
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