If a doctor doesn't submit the claim to the carrier automatically (such as out-of-network providers), here is how a claim can be submitted manually to the carrier for reimbursement.
There are generally two types of claim forms: a medical claim form, or a prescription drug reimbursement form. Here's a quick comparison: Medical Claim Form A medical cla... Learn more
Any time someone receives a service from a provider, the service(s) rendered are tied to established Procedure Codes. These codes are used to tell the insurance carrier wha... Learn more
Here are some tips on manually submitting claim forms to a carrier: Finding The Right Form Determine whether a Medical Claim Form or a Prescription Drug Reimbursement For... Learn more
Subscribers can dispute claims if they believe their carrier has processed a claim incorrectly according the plan's Explanation of Benefits (EOB). The carrier will review the di... Learn more
The Explanation of Benefits (EOB) is a document sent by carriers to provide details on how a claim was processed. Even if the carrier didn't pay anything for the service, subscr... Learn more
The allowable amount (also referred to as allowable charge, approved charge, eligible expense) is the dollar amount that is typically considered payment-in-full by an insurance ... Learn more
In balance billing, the provider bills a subscriber for the difference between the provider’s charge and the allowable amount. For example, if the provider’s charge is $100 ... Learn more