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KY Medicaid MMS Batch Health Care Professional Health Care Claim and Encounter Claims (837P) Companion Guide Version 1.0 FINAL Version 005010 X222A1 Cabinet for Health and Family Services Department

How to fill out professional health care claim

To fill out a professional health care claim, follow these steps:

1. Gather necessary information: Collect all relevant documents such as medical bills, receipts, and insurance information. Make sure you have the details of the healthcare provider and the services received.
2. Identify the claim form: Determine the specific form required by your insurance company or healthcare provider. It could be a CMS-1500 form for private insurance or a UB-04 form for hospitals and other facilities.
3. Patient information: Fill in the patient's personal details like name, address, date of birth, and insurance policy number. Provide accurate and up-to-date contact information, as it will facilitate communication throughout the claims process.
4. Healthcare provider information: Include the name, address, and contact details of the healthcare provider who rendered the services. You may also need to mention their National Provider Identifier (NPI) and Tax Identification Number (TIN).
5. Service details: Describe the healthcare services provided, including the dates of service, CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes, and any relevant diagnoses. Ensure that the information is specific and corresponds accurately to the medical documentation.
6. Billing information: Indicate the billed amount for each service and any applicable modifiers or units. If there is an agreed-upon fee schedule with the insurance company, mention that as well. Attach the itemized bills and supporting documentation, if required.
7. Insurance information: Provide details about the patient's insurance coverage, such as the insurance company's name, address, and phone number. Include the policy or group number, along with any secondary or tertiary insurance information if applicable.
8. Authorization and signatures: If necessary, obtain the patient's signature for releasing medical information and assigning benefits to the healthcare provider. Additionally, sign and date the claim form yourself as the claimant or authorized representative.
9. Review and submit: Thoroughly review the completed claim form, ensuring that all sections are accurate and legible. Make copies for your records before submitting the claim to the insurance company or healthcare provider as instructed.

Who needs a professional health care claim?

Individuals who require reimbursement for medical expenses or seek coverage for healthcare services may need a professional health care claim. This includes patients who have private insurance plans or those who utilize government programs like Medicaid or Medicare. Healthcare providers, such as doctors, hospitals, laboratories, and other medical facilities, also need to submit claims to receive payment for their services.

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What is professional health care claim?

Professional health care claim is a formal request for payment submitted by a health care provider to an insurance company or government agency for services rendered to a patient.

Who is required to file professional health care claim?

Health care providers such as doctors, hospitals, and clinics are required to file professional health care claims for reimbursement of services provided to patients.

How to fill out professional health care claim?

Professional health care claims can be filled out by providing detailed information about the services provided, patient information, and insurance details using standardized forms or electronic submission methods.

What is the purpose of professional health care claim?

The purpose of professional health care claim is to request payment for the services provided by health care providers to patients covered by insurance plans or government health care programs.

What information must be reported on professional health care claim?

Information such as patient details, diagnosis codes, procedure codes, dates of service, provider information, and insurance details must be reported on professional health care claims.

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