There are certain items that are mandatory when you call a patient’s insurance company.
Such requirements are dictated by the Data Protection Act.
Without them it’s highly unlikely without the right information you can make an enquiry regarding a patient.
You MUST have:
The Policy Number Patients name Patient’s FULL address The POST CODE Patient’s Date of Birth Treatment date CCSD code
Pre-authorisation number is very useful too.
Just this morning I was asked my a client to speak to a certain insurance company regarding a new patient. But all the client had was the patient’s name and policy number. Even though I know better I thought I’ll speak to the insurance company to see if the requirement to quote address, postcode and date of birth etc have changed.
They haven’t. So I had to call the client and get the details anyway. It would have been must easier if the client had furnished the right data to begin with.
But what do you do if you don’t have the policy number?
If you have the patients name, full address (inc the postcode!) and date of birth you stand an extremely high chance of the insurance company telling you the policy number. Indeed often I’ve had to speak with an insurance company to obtain the policy number.
With the above to hand, it’s not an issue. Use the opportunity to confirm or obtain the pre-authorisation reference as well though.
This despite what many think is important for if you have say 12 to do, it’s going to take time.
So, the very best thing to do is to make sure the clinic list has absolutely everything you need in order to invoice correctly.
That way, you won’t have to contact the insurance company first. Also of course, if there is an invoice query after you’ve billed the consultation / episode you will have all the data in front of you when you DO speak to the insurance company.
There are and shouldn’t be any excuses whatsoever – you MUST get the information required right up front.
If don’t you start on the back front to begin with.
pete@medicalhealthcaremanagement.co.uk
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