Check out provider processing manuals from carriers you interact with, if available. These guides will help you determine what documentation is required by carriers for procedures you submit. Criteria can change with new versions so be sure to stay current. The manual can often times be found on the carrier’s provider portal. The exact location will differ between carriers, so be sure to explore the provider resources part of the portal. Examples of commonly found guides:
- Clinical documentation requirements
- Claim filing guidelines
- Outline of appeals process
Tip: Processing manuals may be large – sometimes over 100 pages! Be sure to update your copy yearly.
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