Please provide us the following information:
Status
1
List of insurance carriers that you are participating with.
Required
2
A sample of 10 different Paid EOBs and 10 Denied EOBs (various ins. co.)
Required
3
List of your CPT codes and Fee schedule.
Enclosed
To follow
Not available
4
Current procedure utilization report
Enclosed
To follow
Not available
5
List of your ICD-9 codes
Enclosed
To follow
Not available
6
List of all modifiers you are using
Enclosed
To follow
Not available
7
A copy of all your current forms: Patient history, Superbill, Demographic etc.
Enclosed
To follow
Not available
8
Patient Billing Policy (attached form)
Enclosed
To follow
Not available
9
A copy of your office policy, including telephone and scheduling policy
Enclosed
To follow
Not available
10
Top 10 denial code reasons
Enclosed
To follow
Not available
11
Copies of Ten (10) assorted random charts from each provider
Enclosed
To follow
Not available
12
Aged Receivables (A/R) by Service Date: Patient balances and Insurance Plan
Enclosed
To follow
Not available
13
Sample of practice’s Letter Head
Enclosed
To follow
Not available
