Saturday, February 25, 2012

The importance of double checking

The identifying numbers like the NPI number and tax ID number are very important pieces of information in medical billing. If a medical claim is submitted with the wrong NPI number it will not be paid. The NPI and tax id are part of the the provider demographic information along with his/her name, address, phone. This information must be accurate to avoid claim denials. 

When you are performing credentialing initially, you must check, double check, even triple check all of this information on the applications and with the insurance company as they process the applications. As well, always triple check how you enter this information in to your practice management system (medical billing program). 

When you begin a new job with a practice, checking to be sure that the information is valid is a great idea!! A phone call to the insurance company to confirm that your information and theirs match will save a ton of time in the end. 

If you discover that any demographic information (including the tax id, NPI, or provider numbers) is wrong, correct it. First determine who has the wrong information. Is the insurance wrong or are you? Double and triple check before changing anything! If the insurance is wrong, ask the representative how you can make the correction. Usually the representative will refer you to the credentialing department. 

There are different corrective actions depending on the problem. For example, if the insurance has the wrong tax id associated with the provider number, often a short form or letter will fix the information.  If the problem is an invalid practice location a longer form may be needed. Any time that you are dealing with the credentialing department, you must follow up regularly to see what the status of the change is, again it is wise to keep a detailed log of your telephone calls and actions. 

If you discover that the error is on the practice side, correct it. Modify the invalid provider record in the practice management system. The most important step to this is to be sure to RESUBMIT ALL OUTSTANDING CLAIMS after you have made the corrections. You can guess that these claims weren’t paid because they had an invalid provider number or other provider information. 

There are a couple of things to think about if you suspect a provider number problem. They are listed to follow:

1) Are the individual and the group provider number in the right place in the practice management system? Could they possibly by switched?
2) Could a letter O really be a number 0?
3) Is the provider number linked to the correct tax id?
4) Are the provider numbers listed in your practice management system connected to the right doctor within your practice?


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