University of Houston s4

UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY UNIVERSITY EYE INSTITUTE

CLINIC BUSINESS OFFICE • POLICY 30.0 February 15, 2008

Primary and Secondary Insurance Claims

It is the policy of the University Eye Institute to submit clean claims to third-party payers in a timely manner as a courtesy to patients and in an effort to receive prompt payment for services rendered.

PROCEDURES

1. Prior to submitting claims, charges are reviewed automatically or manually for accuracy.

a. Every effort is made to eliminate errors in registration, procedure, and diagnosis coding and charge entry to ensure timely reimbursement.

b. During the review process, any discrepancies are resolved immediately.

c. If necessary, the clinic rendering the service for which the charge is being billed is contacted in person or an internal e-mail communication regarding the charge.

d. Charge edits are resolved in four business days.

2. Following the edit process, clean claims are sent electronically real-time or by the end of the business day.

3. Exception reports generated from the submission are worked on a same-day basis.

4. Claims are not suspended unless absolutely necessary.

5. The Clinic Business Office submits secondary claims in the event that a patient maintains a secondary insurance policy and the primary insurance carrier does not pay the full amount of the charge.

a. The secondary insurance carrier is billed for the remainder of the balance.

95 b. The Clinic Business Office makes best efforts to work with payers to crossover secondary claims automatically.

c. If not, the primary explanation of benefits (EOB) is flagged manually or electronically, and submitted to a Clinic Business Office to bill the secondary insurance carrier.

d. Within 24 hours of notification of responsibility of the secondary payer, the secondary claim(s) are submitted.

7. The full balance of primary and secondary claims submitted to third-party payers with whom the The University Eye Institute does not participate are transferred to patient responsibility at 45 days, or another time period that the business office designates.