“Clean claim” filing tips for healthcare providers

Medical professionals like doctors should understand that they should provide the necessary documents needed for them to be paid by the insurance carriers of the patients they have treated.

A small error in the claiming process after a professional service is rendered to a patient may result to Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO) either delaying or denying health providers of their deserved compensations. Aside from filing in a timely fashion, doctors should make sure that all receivable documentations needed by insurance carriers are provided. Information like names, addresses and other information should be error-free for health providers to also timely get their compensations.

While the Texas prompt pay lawyers at Williams Kherkher state that health providers are protected by the Texas Prompt Pay Act of 2003, they also note that many HMO and PPO companies wrongfully deny or delay the compensations deserved by hardworking healthcare providers. Health providers may experience delay from insurance carriers that are very critical in details. At some point carriers may request additional details to healthcare providers who have already filed a clean claim if they are suspecting fraud.

To possibly avoid such frustrating hassles, tips like documenting status claims including mails, regular updating of account receivables and recording phone calls with insurance carriers regarding claims can be done. Such documentation is highly crucial for healthcare providers who have decided to file a complaint to the Texas Department of Insurance (TDI). Copies of health insurance cards of patients and all the printed and digital transactions between a healthcare provider and carriers can be used as evidence when filing a complaint to the TDI.

Healthcare providers who believe that their compensations are either delayed or denied by carriers should also know that there are lawyers who provide legal assistance for claims regarding the prompt pay act.