Verifying the patient’s insurance benefits
The importance of patient’s Insurance Verification
Most healthcare professionals don’t like dealing with insurance, but in the US managed care is part of the landscape. As most patients receive healthcare from their employer, each insurance plan can be significantly different, even when issued from the same corporation at the same insurance company. This is why it is important to understand each patient’s insurance independently.
What is the healthcare insurance verification process?
It starts with the patient demographic information from the patient’s insurance healthcare card and driver’s license. This confirms that the person seeking care is the actual person on the photo ID, minimizing insurance fraud. This the patient demographic information is included on outpatient form for insurance claim billing CMS-1500.
Patient Scheduling
The new patient will enter their demographic information into an EHR software or complete an intake form. For insurance purposes, the required information needed is the following; full name, date of birth, street address, and sex of the name on the insurance card. In the case the patient is a minor, the provider’s office will need the demographic information for the guardian or person(s) responsible for the charges.
Eligibility and Verification
It is best to confirm all the information upfront, which allows the claim submission process to happen seamlessly. We will contact the insurance company to confirm several points on the insurance;
- The insurance policy is active
- If authorization is required for the services to be rendered
- What are the insurance benefits?
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- What is the patients’ out-of-pocket responsibility?
- Whether they have a copayment or a deductible?
- If a deductible, what are the accumulations towards the deductible?
- If a deductible, what is the coinsurance?
Patient Responsibility
We will forward to the provider a form with insurance details to report the patient’s insurance benefits. The form will show the patient’s out-of-pocket expense at the time of service, whether, they have a copayment, for example, $25 or they have a deductible. In the case the patient has a deductible, the provider is to collect the “allowed” rate for the service codes;
- CPT code 90791
- CPT code 90832
- CPT code 90834
- CPT code 90837
- CPT code 90846
- CPT code 90847
- CPT code 90853
- Mental Health is covered by the third-party insurer
It is common with mental health that the company on the front of the healthcare insurance card that services the mental health benefits is different. It is our responsibility to locate the proper third-party insurance company and verify the patient’s benefits. In this case, the servicing insurance company is different, we need to verify if they are following the network status of the original healthcare insurance company. In these examples, this is when an Mental Health Insurance billing company can add value to your practice.
New information required when submitting to third-party insurance
When submitting mental health claims to a third-party health insurance, they will have different information to identity your patient from the original health insurance company, such as, Aetna, Blue Cross, Cigna Healthcare, or United Healthcare. In this case, the mental health therapist will not be submitting claims to Blue Cross, but to the third party insurance company.The new information that will need to be obtained when calling the provider services number for the new insurance company
- Name of the health insurance to receive the behavioral health insurance claim
- Payer ID for the insurance company
- New Member ID for the patient (if applicable)
- Phone number for the new third-party insurance carrier
- This a list of the largest Behavioral Health insurance carriers;
- Beacon Health Strategies
- ComPsych
- HealthGrams
- HealthPlans
- Magellan Health
- United Healthcare
With the patient demographic confirmed and the insurance is active we can submit claims to the proper insurance company after each (DOS) date of service. With accurate patient information, we can accomplish the submission of a clean and fluid claim, without any “Denials” or “Rejections” in the claims process. Which allows for all claims to be successfully entered into the insurance company’s claims system for adjudication for reimbursement.
When we verify your patien’t insurance benefits, we will get answer to the below questions:
-
- Example: $750
- With $5,250 remaining
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
-
- Does the patient have a copayment?
-
- If so, what is the copayment?
-
- Example: $25
-
- If so, what is the copayment?
-
- Does the patient have a copayment?
-
- Does the patient have a deductible?
-
- If so, what is the deductible amount?
-
- Example: $3,000
-
- If so, what is the deductible amount?
-
- Does the patient have a deductible?
-
- What are the accumulations towards the deductible?
-
- Example: $750
-
- With $2,250 remaining
-
- What are the accumulations towards the deductible?
-
- After the deductible is obtained, what is the coinsurance?
-
- Example: 20%
-
- After the deductible is obtained, what is the coinsurance?
-
- What is the (OOP) out-of-pocket maximum?
-
- Example: $6,000
-
- What is the (OOP) out-of-pocket maximum?
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
-
- Does the patient have a copayment?
-
- If so, what is the copayment?
-
- Example: $25
-
- If so, what is the copayment?
-
- Does the patient have a copayment?
-
- Does the patient have a deductible?
-
- If so, what is the deductible amount?
-
- Example: $3,000
-
- If so, what is the deductible amount?
-
- Does the patient have a deductible?
-
- What are the accumulations towards the deductible?
-
- Example: $750
-
- With $2,250 remaining
-
- What are the accumulations towards the deductible?
-
- After the deductible is obtained, what is the coinsurance?
-
- Example: 20%
-
- After the deductible is obtained, what is the coinsurance?
-
- What is the (OOP) out-of-pocket maximum?
-
- Example: $6,000
-
- What is the (OOP) out-of-pocket maximum?
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
-
- Does the patient have a copayment?
-
- If so, what is the copayment?
-
- Example: $25
-
- If so, what is the copayment?
-
- Does the patient have a copayment?
-
- Does the patient have a deductible?
-
- If so, what is the deductible amount?
-
- Example: $3,000
-
- If so, what is the deductible amount?
-
- Does the patient have a deductible?
-
- What are the accumulations towards the deductible?
-
- Example: $750
-
- With $2,250 remaining
-
- What are the accumulations towards the deductible?
-
- After the deductible is obtained, what is the coinsurance?
-
- Example: 20%
-
- After the deductible is obtained, what is the coinsurance?
-
- What is the (OOP) out-of-pocket maximum?
-
- Example: $6,000
-
- What is the (OOP) out-of-pocket maximum?
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
-
- Does the patient have a copayment?
-
- If so, what is the copayment?
-
- Example: $25
-
- If so, what is the copayment?
-
- Does the patient have a copayment?
-
- Does the patient have a deductible?
-
- If so, what is the deductible amount?
-
- Example: $3,000
-
- If so, what is the deductible amount?
-
- Does the patient have a deductible?
-
- What are the accumulations towards the deductible?
-
- Example: $750
-
- With $2,250 remaining
-
- What are the accumulations towards the deductible?
-
- After the deductible is obtained, what is the coinsurance?
-
- Example: 20%
-
- After the deductible is obtained, what is the coinsurance?
-
- What is the (OOP) out-of-pocket maximum?
-
- Example: $6,000
-
- What is the (OOP) out-of-pocket maximum?
- What are the accumulations for the out-of-pocket maximum?
-
- Example: $750
- With $5,250 remaining
-
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
