Healthcare Coding for Insurance Carriers

One of the best ways medical coders can uphold proficiency with their coding skills is to understand each health plan’s specific billing and coding guidelines:
• Maintain a current list of payers pertinent to the demographic area you code for.
• Link provider id numbers, npi numbers and tax id numbers to each plan and telephone numbers.
• Record website addresses for each insurance carrier and set up a favorites list on your computer for quick access
• Keep a notebook of user name and passwords for each payer website. (If you are unable to set this up on the web, a practice manager may have administrative access and can add your name to the user list.)
• Design cheat sheets for specific problem areas such as modifier restrictions, specific rules for billing E/M visits and surgical procedures on the same day, the number of diagnosis codes accepted per line on a claim form.
• Sign up for health plan newsletters and notifications. Most carriers will e-mail you up-to-date news as well as quarterly newsletters.

There is a myriad of information out there that coders can obtain through Internet access, and visiting a payer’s website will directly remove any issues a coder may wonder about.

With computer technology and easy access to the Internet, both coders and billers have the ability to not only learn about specific coding regulations on line, but can view their submitted insurance claims to oversee the status of their work. Most major and local carriers will allow you to go directly to a claim status link and make the necessary corrections on a claim for faster payment to the provider.

Although there are a few carriers that require appeal forms to correct healthcare coding errors, certain plans will allow you to make corrections over the telephone. As an example, NHIC Medicare Part B, will allow you to call their toll free number (1-877-757-7781) and make changes on CPT® codes and modifiers only. When calling the carrier, have your npi, last 5 digits of the provider’s tax id number, and Medicare PTAN available or you will be denied access.

Start creating your lists today for each carrier` and become an even more impressive certified coder!

healthcare coding for insurance carriers

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About the Author:

JoAnne Sheehan
JoAnne Sheehan has been successfully providing medical billing, coding and practice management services in the New England area for over thirty-three years. She has witnessed the evolution of healthcare and the increased complexities of medical billing and coding regulations, creating a need for education in this field. JoAnne has been featured in numerous medical publications and has acted as a medical billing expert in highly profiled Medicare and Medicaid fraud cases in Boston and has trained others on both a local and national level in medical billing and coding. She is a certified medical coding instructor, practice management consultant, and an AAPC approved ICD-10-CM instructor. Her hands-on experience is an asset for the CCO students she coaches. She is President and Founder of Lomar Associates, Inc., a practice management company established in 1981.

One Comment

  1. Richard November 19, 2012 at 11:29 pm - Reply

    Medical coding websites are very important to see their submitted insurance claims and to oversee the status of their work and make the necessary changes. Thanks for sharing this post to us.

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