Cheat Sheet for Billers Medical

Yonke imisebenzi yehhovisi lezokwelapha elibhekele ukukhokha nokuqoqa izinkokhelo - kusukela ngesikhathi isiguli sihlelelwe ukuqokwa kuze kufike isikhathi sokukhokha kwenkampani yomshuwalense - kubaluleke kakhulu ekukhuliseni ukubuyiswa komshuwalense. Ukubunzima kokukhokha kwezokwelapha kanye nezidingo zezinkampani ezahlukene zomshuwalense kungenza kube nzima ehhovisi lezokwelapha ukuhambisa ngempumelelo nokuqoqa izinkokhelo zezokwelapha.

Ukudala ishidi lokukopela kwabasebenzi bakho behhovisi lezokwelapha kungasiza ukwenza ukukhokhela nokuqoqa izinkokhelo kulula kakhulu.

Nazi izinto ezingu-7 okufanele uzifake kuphepha lakho lokukhohlisa lehhovisi lezokwelapha.

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Abakhokhisi Bomshuwalense

Qala uhlu lwakho ngokukhomba abakhokha ukuthi odokotela noma isikhungo senziwa isivumelwano. Lokhu kufaka phakathi lonke ulwazi lokuxhumana olufana nekheli lezimangalo, iwebhusayithi, kanye nezinombolo zocingo zomhlinzeki wolwazi.

Ungakhohlwa ukufaka:

• Medicare
• I-Medicaid (ngombuso)
• I-Blue Cross Blue Shield (ngombuso)
• I-Cigna
• I-Aetna
• I-United HealthCare
• Tricare

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Ukufakela ngesikhathi

Qaphela isikhathi sokugcina isikhathi sokuthumela umshwalense ngamunye. Khombisa inani lezinsuku umhlinzeki kufanele afake isimangalo ngemuva kokuthola amasevisi. Imingcele yokufaka ngesikhathi esifanayo ichazwe kwisivumelwano somhlinzeki.

Ezinye izibonelo zezikhathi zokugcina zokufaka zifaka phakathi:

• I-Medicare : Izimangalo kufanele zihanjiswe kungakapheli unyaka owodwa emva kosuku lwenkonzo.
• Ukunakekelwa Kwezempilo Kwe-United: Imingcele yokufaka ngesikhathi esifanele ichazwe kwisivumelwano somhlinzeki
• I-Cigna: Ngaphandle kokuba umthetho wezwe noma omunye uhlukile usebenza -
  1. Abahlinzeki bokunakekelwa kwezempilo abathintekayo banezinyanga ezintathu (3) (izinsuku ezingu-90) ngemuva kosuku lomsebenzi.
  2. Abahlinzeki be-out-of-network banezinyanga eziyisithupha (6) (izinsuku ezingu-180) ngemuva kosuku lwenkonzo.
• I-Aetna: Ngaphandle kokuba umthetho wezwe noma omunye uhlangothi lusebenza -
  1. Odokotela banezinsuku ezingu-90 kusukela ngosuku lomsebenzi ukuhambisa isimangalo sokukhokha.
  2. Izibhedlela zinonyaka owodwa kusukela ngosuku lwenkonzo ukuhambisa isimangalo sokukhokha.
• I-TRICARE: Izimangalo kufanele zithunyelwe kungakapheli unyaka owodwa emva kosuku lwenkonzo.

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Ukuqinisekiswa nokugunyazwa kwangaphambili

Khombisa ukuthi yiziphi abakhokhisi bomshuwalense abadinga ukugunyazwa kanye / noma ukudluliselwa kanye nokuthi yiziphi izinqubo. Futhi, faka inqubo yalokho umkhokheli ngamunye ayenayo ukuze athole ukugunyazwa nokuthi yiluphi ulwazi abadinga ukucubungula ukugunyazwa.

Okuningi

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Ukuvama

Cacisa imvamisa evunyelwe izinsizakalo ezithile noma izinqubo zomkhokhi. Lokhu kufaka phakathi nenani lezinqubo ezivunyelwe kanye nenqubo yokwenza izinqubo eziningi zokukhokha.

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Ukufakwa kwezicelo

Khombisa indlela kanye nohlobo lwesimangalo oludingekayo ukuhambisa izimali kumuntu ngamunye okhokhela umshuwalense kubandakanya izimangalo ze-elekthronikhi, izicelo zephepha, izimangalo ezilandelayo, kanye nezicelo ezilungisiwe.

Abakhokhi abaningi badinga ukuthunyelwa kwe-electronic kokubili izicelo eziyinhloko neziyisithupha besebenzisa ifomethi efanele yezicelo zobuchwepheshe noma zezikhungo .

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Izidingo zokukhokha

Abakhokhisi bomshuwalense kudingeka bahambise ukukhokha esikhathini esithile, ngokuvamile izinsuku ezingama-30. Hlola ngenkontileka yakho yokukhokha ukuze unqume ukuthi yikuphi uhlaka ongalindela ukuthola ukukhokha kusuka kumkhokheli ngamunye ngokulandela isimo sesimangalo.

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Izikhalazo

Thola inqubo yezikhalazo ezidingekayo kumkhokheli ngamunye. Ikhampani ngayinye yomshuwalense inesikhathi sokugcina isikhathi esifanele futhi ngezinye izikhathi lapho izimangalo zingasombululwa ngaso leso sikhathi, zingashiywa kuma-akhawunti atholakele okwesikhathi eside kakhulu ehluleka ukwenza isikhathi sokugcina sokufaka.

Uma kwenziwa kahle, izimangalo zezokwelapha ezikhangayo zingaba indlela ephumelelayo yokuxazulula nokuthola inkokhelo yalezo zimangalo eziphikisiwe ngenxa yezizathu ngaphandle kwezimaphutha zokubhalisa ezilula.

Okuningi