Author Topic: New member question(s)  (Read 37 times)

uiucspeech

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New member question(s)
« on: August 08, 2018, 11:14:43 AM »
I apologize if this is long. I work for a state University in their Speech and Hearing Department. I work at the clinic for the department where graduate students, under licensed SLPs, provide speech therapy services to clients. We have recently started accepting health insurance. At this time, we can only submit paper claims as the clinic is shifting to become HIPAA compliant. We are contracted with exactly one health insurance company at this time but are working to add 3 more (1 private and 2 Medicaid). I have come across multiple issues when billing. I was trained one way but as I have read the instructions for the 1500 Claim Form it seems that some of that training is outdated. I will save most questions for when the situation arises but do have a couple that are more general and will ask them here. I hope this is an okay section to ask these questions.

1. For the insurance company which do have a contract with, we have 2 providers who are not individually credentialed at this time. We are working to get this done. In the meantime, we were told that we could bill as the group, under our EIN, and have the services covered. My understanding, from reading the instruction manual for the 1500 Claim form, is that I would put nothing in sections 24I or 24J, in 32a and 33a I would place our facility NPI, and in 33b I would put ZZ along with our taxonomy code. Is this correct?

2. For the same situation as in question one, when we seek to obtain pre-authorization (required) I must select a clinician here who is already credentialed. That person is not signing the claim form. In this situation can the clinician for whom the approval was given sign the form if I complete 24I as ZZ with our taxonomy code and 24J with the NPI for whom the approval was given?

Thank you for any guidance you can provide! I have tried to find possible webinars I could attend where I might learn some of this information but it seems that all of the webinars I could find were for members of associations to which I could not possibly apply for membership.

Michele

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Re: New member question(s)
« Reply #1 on: August 10, 2018, 06:57:42 AM »

1. For the insurance company which do have a contract with, we have 2 providers who are not individually credentialed at this time. We are working to get this done. In the meantime, we were told that we could bill as the group, under our EIN, and have the services covered. My understanding, from reading the instruction manual for the 1500 Claim form, is that I would put nothing in sections 24I or 24J, in 32a and 33a I would place our facility NPI, and in 33b I would put ZZ along with our taxonomy code. Is this correct?

I have not heard of being able to leave box 24J blank.  You did not mention the individual insurance carrier that you are talking about however I do not know of any insurance carrier that would allow the rendering provider information to be left blank for ST.  You could try it, but I would expect a denial. 

Some insurance carriers do require the taxonomy code in box 33b so if they are telling you that then yes.  Otherwise it is left blank.


2. For the same situation as in question one, when we seek to obtain pre-authorization (required) I must select a clinician here who is already credentialed. That person is not signing the claim form. In this situation can the clinician for whom the approval was given sign the form if I complete 24I as ZZ with our taxonomy code and 24J with the NPI for whom the approval was given?

Since you are a group of STs I would try to get the auth under the group instead of the individual therapist.  It would not be uncommon for a situation to arise where a different therapist within the group treated the patient. 


I hope that is helpful!
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uiucspeech

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Re: New member question(s)
« Reply #2 on: August 13, 2018, 08:54:27 AM »


"I have not heard of being able to leave box 24J blank.  You did not mention the individual insurance carrier that you are talking about however I do not know of any insurance carrier that would allow the rendering provider information to be left blank for ST.  You could try it, but I would expect a denial."

The particular insurance company who told us to bill under the group rather than the individual provider was Health Alliance. I asked them if I needed to leave the individual NPI completely off of the claim form and they indicated yes. Then, when reading the instruction manual from NUCC for the 1500 Claim Form it stated "Report ID# in items 24I and 24J only when different from data recorded in items 33a and 33b." So I put the group NPI in 32a and 33a (33b I use the modifier ZZ along with our taxonomy code). This did result in a denial but they were basing it off of the provider not being in-network. I contacted them via phone and after some discussion they indicated they were going to process it back through and approve it. They did do that. There advice to me to ensure getting an approval was to use our Tax ID. I use that on all of my claims I submit no matter which insurance company I am sending it to. I feel at a disadvantage as I have never worked as a medical biller and have absolutely no training. I considered seeing if I could get my employer to pay for training for me but after reviewing different options for this training, I have determined that they will not believe it is cost effective as medical billing is a very small portion of my job and I don't even have to figure out the codes myself. I am going the ICD-10 codes and CPT codes for every single patient we do billing for. I just have to muddle my way through and hope I can catch on to some information that will make my claims more successful!


"Since you are a group of STs I would try to get the auth under the group instead of the individual therapist.  It would not be uncommon for a situation to arise where a different therapist within the group treated the patient.


I hope that is helpful!"


I am going to look and see if I can get the authorization under the group as often as possible. I think that is an excellent suggestion! I do appreciate your response and it was definitely helpful to me.