Insurance claims billing and collection is an extremely complicated process. Medical providers and their staff constantly have to make sure that their payer claims are paid by insurance carriers, let alone paid appropriately. While payers rush to make their clinical reimbursement policies more and more complicated, a large portion of medical bills awaits payments because of a pure bureaucracy. Namely, it is quite common for insurance companies to request some additional forms from healthcare providers prior to issuing claim payments. Normally, healthcare providers receive such inquiries for additional information swiftly upon claim submission. Receiving such a request does not mean that there is something wrong with your practice or claim, nor does it imply that a claim is will not be paid.

  Let us fill the gaps you may have in regard to this topic & talk about the most popular forms that you have probably filled at least once in your lives to have your claims paid.

I.               W-9, because insurances need to know how you pay taxes

  Healthcare practitioners who bill benefit plans out-of-network often receive requests for additional information related to their billing address and tax ID information before they get paid for claims. Specifically, insurance carriers tend to ask healthcare providers to fill, sign & submit a W-9 form, issued by the Internal Revenue Service. This form, if filled appropriately, contains information on the provider’s tax ID, billing address, name, and signature. There is no need to provide a Social Security Number.

  You should not be afraid to indicate all the requested information. Indeed, you should be as precise as possible, because in most cases the purpose of a W-9 form request is to find out where to mail you a paper check. Since this form requires providers to indicate a billing address, requesting & submitting such a form is an easy way to make a claim paid, both for an insurance payer and a healthcare provider.

  This form can be downloaded from the IRS website: https://www.irs.gov/pub/irs-pdf/fw9.pdf

II.             Waiver of Liability for you not to bill a patient if your appeal gets denied

  Insurance payers care about their reputation. Therefore, they are doing their best to ensure the financial well-being of their patients. Namely, members are protected from high-dollar surprise bills. If your claim gets denied, you will most likely appeal it. However, sometimes appeals do not help because there is a strong & legitimate reason behind a denial, and it has occurred purely because of a provider’s fault. In order to protect plan subscribers from unnecessary medical bills, insurances often ask healthcare providers to sign an acknowledgment form stating that no bill shall be sent to a patient even if an appeal upholds an original decision. This form is called “Waiver of Liability”, and it looks different depending on the payer. However, in most cases, the provider’s signature, date, and address are everything that is required in this form.

III.           Coordination of Benefits (COB) for your patients to deal with their coverage

  Some patients often switch their benefit plans. While one payer can be “primary” in December, this may not be the case in January. Such a changeability often leads to small chaos, because payers do not know if they are supposed to pay for a claim or not. In such cases, insurances contact rendering providers and mail a form to them, requesting practitioners to contact an affected patient and submit this form to his/her payer. COB form is also unique for each payer, and a patient normally needs to indicate his/her demographics and contemporary coverage information.

IV.           Provider Credentials form to ensure that all is set up

  Often, insurance payers lack some information on your demographics in their system. Specifically, it is quite common for a license number or an NPI to be missing. Hence, insurance cannot pay for your claims until this information is provided. Subsequently, you can receive a letter asking you to provide the missing information. Please note that should you get such a request more than once – there is something wrong with your credentialing, and you should contact the payer as soon as possible.

V.             Authorized Representative form for you to act on behalf of your patients

  In some cases, your patients may wish to file an appeal to their insurance (for example, when a patient’s responsibility has been applied incorrectly). However, they may be unable to do that on their own. There is an option to ask one’s healthcare provider to submit a letter of complaint on behalf of a patient to an insurance carrier.  Should you & and your patient decide to do so and notify the payer about it, you will shortly receive a letter from the insurance. This will be a form asking for the demographic data of you and your patient, and signatures.

 Received a form from an insurance and unsure what to do with it? Contact us!