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Filling out the charges part on the claim form

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lauracollins:
Hi,

I've just started my own practice and I am new to filing claims.  I want to file a claim for a patient who has coverage through Optum (I'm in-network) for their behavioral health.  On the online claim form where it asks you to enter charges, do I put my charges for that particular service or do I put what the fee reimbursement is for my contract with Optum for that service?  Thanks,

Laura

Michele:
Technically you can put either.  We recommend that you put your regular fee schedule amount and then right off the contractual adjustment once payment is made.

lauracollins:
Thanks Michele!  Do you happen to know what the rules are surrounding dual fee schedules? Is it true that your regular fee schedule has to be the same for all insurances?  Can you have a separate fee schedule for self-pay patients?  Thanks, Laura

Michele:
You are supposed to charge the same to all patients, regardless of insurance or lack of.  Otherwise it may be considered insurance fraud, or it may break contracts that you have with insurance carriers.  The safest route is to charge the same for all patients.  However, there are some things you can do if you are looking to have a lower rate for patients without insurance.

lauracollins:
Thanks so much for clarifying!  Super helpful - I just wanted to make sure I understood after reading up on all this.  What are some ways around possibly charging less if the patient doesn't have much money?  If they have medicaid, but I'm not yet a medicaid provider, do you know if medicaid would still reimburse me or would I have to charge them the my usual fee for that service?

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