Self-File Your own Claim to get Reimbursed Quick!

So many offices across the country are moving towards out-of-network status with insurance
companies to focus more on healthcare and less on paperwork. Good news is your care is still covered by your insurance.  The only difference is you may have to more involved in getting reimbursed. While many insurance panels have different requirements and policies, the following is required across the board to self-file a claim for your healthcare services:

Doctors Office Provides:
  • Procedure Code & Description
  • Diagnosis Code 
  • Fee for Service
  • Doctor or Provider Name
  • Doctor or Provider NPI (National Provider ID #)
  • Clinic Name and Tax ID Number

Patient Provides
  • Insurance company
  • Insurance plan
  • Membership/Policy Number
  • Group Number, if available
  • Primary Insured's Name (if other than the patient)
  • Employer (if applicable)
You should plan on calling your insurance company at least once to find out how they prefer you self-file.  Our office provides a "Statement of Service" which has all the above information on it already.  Some insurance companies have their own form for patients to use, or they may ask you to file with a standard "HCFA" form.  Your doctors office will have this for you upon request; or, you can get them online.

Once you get the right form and all the information filled out, make sure you have the correct address to mail it to.  Remember mental health coverage is often served out of a different location than the typical medical claim. So the address on your insurance card, may or may not be the right address for you.

The first time you mail in a claim, send it certified.  If they delay or say they didn't get it, you have proof otherwise.  After a few claims have been paid and you have all the right forms and addresses, you can simply mail it.  Getting paid back is easy if you are submitting within their guidelines.

After your first few claims, getting paid is as easy as completing a simple form and mailing it in.  You should get paid back in about 10-15 days.

Happy Filing!