How To Fill Out A Claims Form For Out of Network Reimbursement
This tutorial explains how to submit for reimbursement when receiving cash based pediatric physical therapy services from an out of network provider using a humana claims form as an example.
Your provider may have different information so please refer to your specific form (superbill) for the values you need for your own reimbursement. Not all insurance plans have out of network benefits so please consult your specific insurance prior to receiving any out of network care.
This post contains affiliate links, please see my disclaimer for more information.
Lauren is the owner of Dr. Lauren Baker In Home Pediatric Physical Therapy and provides paid 60-minute online parent consultations for individuals with additional questions internationally. For scheduling please click here.
This video will teach you:
How to fill out an out of network claims form generally
How to fill out an out of network claims form for pediatric physical therapy services
What each section of a claims form means and where to put each code
What a superbill looks like and what each part means
Tips to help you receive your out of network reimbursement quicker and easier
find what you’re looking for
0:45 example superbill and explanation of parts of the form
2:21 medical vs rehab (PT) diagnosis ICD-10 codes
3:16 evaluation codes for physical therapy
3:39 place of service code explanations 11 (clinic) vs 12 (home based)
4:22 CPT code / service codes
5:12 treatment code / service code / CPT code examples for physical therapy
5:40 GP modifier on CPT codes
6:14 multiple code examples
6:52 differences in reimbursement per code
7:32 make payments to section of superbly
7:55 fill out claims form with me Humana claims form example
9:55 fill out the PT section (CPT codes, service description, POS, date of service, etc)
10:18 further explanation difference between POS 11 and 12 (clinic / home)
10:55 CPT code / service description
11:34 multiple codes per date of service example
12:24 provider information
13:44 do not miss adding this specific piece of info for provider section
15:44 tips on being organized to make sure you get payment from insurance company
LINKS IN VIDEO:
Simple Practice which autogenerates my super bills (for therapists) - https://www.simplepractice.com/?p=b2f...
Link to Humana claims form - https://docushare-web.apps.cf.humana....
Get a gorgeous NC landscape print like the one behind me - https://rachelcarterimages.com/buy-pr...
transcription coming soon
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How To Submit For Insurance Reimbursement When Seeing an Out of Network Physical Therapist
cash based physical therapy is a great alternative to in network physical therapy for many reasons, especially if it allows for increased convenience, quality of care, or a provider who you trust. Here is a step by step guide to submitting your receipts for eligible cash based or out of network physical therapy for reimbursement to your insurance company.
cash based physical therapy is a great alternative to in network physical therapy for many reasons, especially if it allows for increased convenience, quality of care, or a provider who you trust. Here is a step by step guide to submitting your receipts for eligible cash based or out of network physical therapy for reimbursement to your insurance company.
Gosh, I’m so glad you’re here. This question is so tough to answer, which is why I spent hours creating a guide to help you figure out what you need in order to submit for reimbursement from your insurance company for eligible physical therapy services. The guide is geared toward Pediatric Physical Therapy services, as I am a primarily pediatric based PT who loves treating infants and toddlers; but the content can be utilized for any Physical Therapy outpatient services. In fact, I have utilized the same steps to successfully receive reimbursement from two different insurance companies for both physical therapy and mental health therapy services.
If you love heartfelt resources and step by step guides that cover what you need, what you should do, and what you need to know in order to have all your ducks in a row to submit for reimbursement from your insurance company for cash based physical therapy or out of network physical therapy services, download the guide below! If you have any specific questions for Dr. Baker, email her (me) here.
