Processing claims is a very important part of daily life in a PT or OT office… and yet, it’s not uncommon to sometimes feel frustrated as though this very procedure is taking over. Take control back by following these few helpful hints:

• When you receive the EOB, compare the total amount allowed to your contracted fee schedule to ensure that you are being reimbursed at your contracted rate.
• The total amount allowed includes the patient’s responsibility.
• The EOB will specify which healthplan or PPO discount was applied.

If a claim is not processing correctly, keep in mind that it could be one of the following:

• Some contracts are loaded under facility not individual therapist. If you bill in box 31 under the therapist name, the system may not be able to match the TIN and would therefore process out of network. “Signature on file” is an acceptable alternative.
• The provider is not loaded into the system correctly.
• The patients benefits are limited and/or authorization was required before treatment was rendered.

In all of these cases a provider’s course of action should be to contact the payor directly and determine why the claim was processed incorrectly. If the provider is informed that they are out of network the next step is to contact PREFERRED’s Provider Relations department for further assistance if it is a PREFERRED contract.

Please remember to always verify benefits before treating a patient, and confirm that you are recognized as a participating provider for any new contracts.