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Re: [MedicalBillers] Re: Billing insurance with incomplete information

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  • Candice Aryitey
    I work for a group of internal medicine docs.  When we see patients in the hospital we have no control over the information that the patient provides. We
    Message 1 of 1 , Jun 10, 2009
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      I work for a group of internal medicine docs.  When we see patients in the hospital we have no control over the information that the patient provides. We often get patient demographics without the subscriber's date of birth.  Our system will not send the claim electronically without a date in that field.
       
      If we do not have the info, we leave the patient's date of birth.  We have had no problems with payment. When I asked an insurance carrier about this we were told that the system first checks for a valid subscriber ID and whether or not a family member with the patient's DOB is listed under that subscriber ID.  If it all matches, the claim is paid.
       
      Thanks,

      Candice

      --- On Tue, 6/9/09, Josie Mapp <jgpservice@...> wrote:


      From: Josie Mapp <jgpservice@...>
      Subject: Re: [MedicalBillers] Re: Billing insurance with incomplete information
      To: MedicalBillers@yahoogroups.com
      Date: Tuesday, June 9, 2009, 5:47 PM








      Even if not needed on the HCFA, you will need the subscriber's birthday when
      calling for the claim or when doing claim status online.

      Josie Mapp

      On Jun 9, 2009 5:21 PM, "kawinaorg" <kawinaorg@gmail. com> wrote:

      Thanks Linda. I guess I expressed some of that badly. As you said, it is
      patient data and we do try to collect it on the patient info form. The
      problem is that new patients are not always capable of providing
      complete information. The biggest issue is that they will not always
      know the subscriber's birth date.

      I checked the official 1500 paper form instructions and there is nothing
      to indicate that subscriber's DOB is required. When something is
      required, they use similar language to Field 11's (Insured's Policy #)
      language where it says " If Item Number 4 (Insured's Name) is completed,
      then this field should be completed."

      I guess as a practical matter it is required, but that seems to be an
      arbitrary standard. Since the insurance companies already have the data,
      it also seems like the kind of bureaucratic make-work that adds
      unnecessary costs to the health care system. But then again, I am new so
      maybe there is a purpose that I do not understand.

      In any case, is there any alternative to providing it when the info is
      just not available?

      Thanks,
      Steve

      --- In MedicalBillers@ yahoogroups. com, "Linda Walker" <linda@...> wrote: > >
      The information about...


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