How to Create a Clean Paper Claim in Medical Billing - dummies

How to Create a Clean Paper Claim in Medical Billing

Although paper claims can be a nightmare to keep clean in medical billing, they are necessary at times. When you have to submit a claim on paper, follow these guidelines:

  • Use only original claim forms (the ones printed in red). The current acceptable forms are the CMS-1500 and the UB-04. (Make sure you’re using the correct edition of the form. On the CMS-1500 form, look for “Approved by National Uniform Claim Committee [with the most recent date of approval]” at the top of the form, and “Approved OMB-xxxx-xxxx Form CMS -1500 [date]” in the bottom right-hand corner.)

  • If you need to write on the claim for any reason, use blue or black ink. The payer processing software does not recognize red ink because the forms are red. (Also keep in mind that some payers don’t accept claims with anything written on them by hand.)

  • Do not submit totally handwritten claims.

  • Make sure that the print on the claims is dark.

  • If the toner in your printer is starting to run low, it may leave blank streaks. Do not send claims out with these streaks.

  • Claims scan best when you use at least a size12 font in uppercase letters. Make sure that the information that is required in each field prints within the area of each block.

  • Processing software doesn’t recognize punctuation, so don’t use it. Nor do you need to use decimal points (separate fields exist for dollars and cents).

  • Don’t send attachments unless the payer requires them.

Paper claims are difficult to track and take longer to reach the payer. If you are forced to submit multiple paper claims to an individual payer, send them certified or registered mail so that you have proof that the claims reached the payer and that somebody at that office accepted the package.

Also check on these claims within a week to make sure that they have been entered into the payer processing system. When you call to follow up a paper claim, let the representative know that the claim was submitted on paper and the date it was sent.

Remember that insurance companies are in business to make money for their investors, and they’ll use any excuse to reject your claim. Paper claims require more handling by the payer, which increases the chances of the claim being entered incorrectly or even lost.