How do I submit a claim?
The process for submitting a claim can vary slightly between different insurance carriers. While there might be some general similarities, it's always best to consult your specific carrier's website or contact their customer service for the most accurate and up-to-date instructions.
General Steps:
Gather Necessary Information: This typically includes:
Your insurance card number
Provider's name and contact information
Date of service
Medical codes (ICD-10)
Procedure codes (CPT or HCPCS)
Your patient information
Obtain a Claim Form: You can usually find claim forms:
Online on the carrier's website
From your healthcare provider
By contacting the carrier's customer service
Complete the Claim Form: Accurately fill out all required fields based on the information you've gathered.
Attach Supporting Documentation: This might include:
Copies of medical bills
Receipts for copayments or deductibles
Explanation of benefits (EOB) statements
Submit the Claim: You can typically submit claims by:
Mail: Send the completed form and supporting documents to the address provided on the form.
Online: Many carriers offer online claim submission portals.
Mobile App: Some carriers have mobile apps that allow you to submit claims.
Specific Carrier Information:
While the general process is similar, there might be slight variations in the specific requirements for each carrier. Here are some resources for the carriers you mentioned:
BlueCross BlueShield: https://www.bcbs.com/support-resources/frequently-asked-questions
UnitedHealthcare: https://www.uhc.com/member-resources/how-to-submit-a-claim
Aetna: https://www.aetna.com/health-care-professionals/claims-payment-reimbursement/electronic-claims.html
Ambetter: https://www.ambetterhealth.com/ - They provide a 2023 Provider and Billing Manual which includes a section on Claims.
Oscar: https://www.hioscar.com/faq/what-is-the-claims-process
Remember to check the specific instructions on each carrier's website or contact their customer service for the most accurate information.
General Steps:
Gather Necessary Information: This typically includes:
Your insurance card number
Provider's name and contact information
Date of service
Medical codes (ICD-10)
Procedure codes (CPT or HCPCS)
Your patient information
Obtain a Claim Form: You can usually find claim forms:
Online on the carrier's website
From your healthcare provider
By contacting the carrier's customer service
Complete the Claim Form: Accurately fill out all required fields based on the information you've gathered.
Attach Supporting Documentation: This might include:
Copies of medical bills
Receipts for copayments or deductibles
Explanation of benefits (EOB) statements
Submit the Claim: You can typically submit claims by:
Mail: Send the completed form and supporting documents to the address provided on the form.
Online: Many carriers offer online claim submission portals.
Mobile App: Some carriers have mobile apps that allow you to submit claims.
Specific Carrier Information:
While the general process is similar, there might be slight variations in the specific requirements for each carrier. Here are some resources for the carriers you mentioned:
BlueCross BlueShield: https://www.bcbs.com/support-resources/frequently-asked-questions
UnitedHealthcare: https://www.uhc.com/member-resources/how-to-submit-a-claim
Aetna: https://www.aetna.com/health-care-professionals/claims-payment-reimbursement/electronic-claims.html
Ambetter: https://www.ambetterhealth.com/ - They provide a 2023 Provider and Billing Manual which includes a section on Claims.
Oscar: https://www.hioscar.com/faq/what-is-the-claims-process
Remember to check the specific instructions on each carrier's website or contact their customer service for the most accurate information.
Updated on: 08/10/2024
Thank you!