Medical Billing Forum

Coding => Coding => Topic started by: Dan on May 11, 2012, 02:29:21 PM

Title: Submitting claims with POS - 3 (school)
Post by: Dan on May 11, 2012, 02:29:21 PM
Does anyone have any experience using POS-3 on claims submitted to private insurance?  We are a peds occupational therapy practice and have several insurance clients who will be reaching school age and their parents want them to receive therapy at a private school.  We do this for some of our private pay patients but we haven't had this issue come up with an insurance patient.  Additionally, we are out of network and don't file claims.  Parents file with insurance; however, we do provide the necessary info on invoices for insurance processing.

We are going to talk to the insurance company, but wanted to know if anyone had any experience with claims being rejected for using this POS and who was insurer.

Title: Re: Submitting claims with POS - 3 (school)
Post by: Michele on May 13, 2012, 04:07:10 PM
I haven't ever billed using POS 3.  Your best bet is to check with the insurance carriers.
Title: Re: Submitting claims with POS - 3 (school)
Post by: PMRNC on May 14, 2012, 08:40:21 AM
I have some mental health providers who see some children in private school setting, insurance carriers won't pay unless medically necessary, they sometimes will pay for the observation for certain instances such as classification but other than that, very difficult unless you can show it's needed AT the school. Most likely if considered you will need authorization anyway so best to call each carrier ahead of time.