Frequently Asked Questions for Old Town Medical Billing

Medical Claims Billing

Question: What do we need to start submitting claims for a provider?

Answer:

  • We will need the provider's practice information and a copy of the provider's W-9. We have an easy-to-use form available on our website for this information although the W-9 will still need to be emailed, faxed or mailed.
  • We will need patient demographic information including name, date of birth, address and insurance information for each patient.
  • We will need an initial diagnosis for each patient and will need to know if that diagnosis changes in the future.
  • We will need a list of charges with the date of service, patient name, and level of care (CPT code). The charge sheets can be sent to us by email fax or mail on a daily weekly or monthly basis.

 

Question: Will you submit my claims electronically or by paper? Will you submit my patient's secondary claims?

Answer: We will submit your claims electronically though our clearinghouse, Zirmed, whenever possible. We also have paper claims (HCFA 1500 forms) if a paper claim is required or needed. We will submit for secondary coverage if a patient has a secondary insurance policy and we have received the primary insurance policy's payment information on the claim.

 

Question: When should I receive a bill?

Answer: We will mail provider billing by the 15th of each month. This bill will include any payments entered the previous month. For example, your January bill will include payments entered during the month of December. Sometimes, we will have to call on claim status or have a claim reprocessed. In this case, you might see a date of service that seems rather old on a current billing statement.

 

Question: Does your company verify patient benefits?

Answer: Yes! We offer this service for $5.00 per insurance verification. Please note that our insurance verifications are based on benefits quoted at the time of our call and we cannot be held liable for any misleading or incorrect benefits information given to us at the time of our call to the insurance company. The verification is not a guarantee of claim payment or processing for the specific patient.

 

Question: How does Old Town/CMC know that I've been paid by the insurance company?

Answer: We rely on the insurance company EOB's for payment information and will need to have those EOB's faxed, emailed or mailed to us until we can set-up electronic remits through our clearinghouse. We will let you know when the electronic set-up is complete with each insurance company although, in some cases, you will need to continue sending us copies of certain EOB's.

 

 

Credentialing

Question: Can I choose which insurance panels I'd like to be credentialed with?

Answer: Absolutely! You can choose one or 10; it's up to you and our fees are based per panel so you will only be paying for the insurance companies you choose.

 

Question: Do you know which insurance panels are available in my area and which panels would be best for me?

Answer: With our experience in the billing and credentialing field, we will definitely know which insurance panels are in your area and available to you. We can give you guidance on each panel based on fee schedules in your area and credentialing timeframes.

 

Question: How long does the credentialing process take?

Answer: Each insurance company works at a different pace and their requirements vary but the usual timeframe is between 90-180 days.

 

Question: What is CAQH and do I need a CAQH number?

Answer: CAQH is an online provider data collection service and many insurance companies will access the database to verify provider participation and eligibility requirements. You will need a CAQH number for the insurance companies to have access to that information. We can request a CAQH number for you through one of the participating insurance companies that you wish to panel with and we can also help with your CAQH application.

 

Question: How will I know my status in the credentialing process?

Answer: That's our job! We will keep in contact with each insurance panel and provide you a weekly update until the process is complete with each panel.

 

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703-361-2678
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