form – KMC University

Sample Recoupment Rebuttal Letter

Download Support Tool This letter can either be used as a template that you can customize and use as needed or that you can use as an example if you prefer to write your own rebuttal letters. It can be a great time saver and help you ensure that you include all of the pertinent...

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Understanding the 1500 Claim Form

The 1500 billing form is the industry standard for submitting claims to third-party payers. Each field has a very specific purpose and it is necessary to map the entry fields from your billing software to the proper location on the billing form. This form represents the basics of the billing process, and knowledge of this...

Patient Acknowledgment for Non-Covered Services & Products

Having Patients Understand What Services are Denied/Excluded From Coverage Some carriers (with whom the doctor may or may not participate) may not allow a particular service or product the patient needs, or their fee schedule assigned to the service or product may be far below the doctor’s costs. Depending on the doctor’s contract with the...

Reference Documents -Verifying VA Coverage

Reference Documents The VA provides an abundant number of resources to assist with managing referrals and submitting authorization request. One of the most helpful tools is the HealthShare Referral Manager system. This online portal helps providers stay on top of referrals. In addition to that gateway is the helpful VHA Training portal. The reference documents...

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Verifying Medicaid Benefits

Medicaid coverage and eligibility can be a moving target since states base policies on current legislation and available funds. Because of the variety of restrictions, it’s vital to confirm benefits for every patient and every visit, in order to bill correctly and compliantly. This tutorial provides guidance on locating information online and additional information on...

Reference Documents Workers’ Compensation Verification

Reference Documents In this module we discussed some of the specific forms that may be required for federal injury claims. Listed below are sample forms that are common when requesting medical authorization as well as directions on billing procedures. As always, we recommend that you check the carrier website for the most current versions. CA-16...