Claim Type

Attachment Needed

Format Required

Air Ambulance

Trip sheet

provider told up front to send in with claim.

Anesthesia

Anesthesia notes, oper report

develop for info when claim received or must provide record with claim.

Cardiac Rehab

Rehab notes, office record

must provide record with claim.

Dental

Operative report, path report, x-rays, perio charting

develop for info when claim received or must provide record with claim.

Blepharoplasties

Operative report, visual field, photos

provider told up front to send in information, if not provided, we develop for missing information.

Lab

Lab results, physician orders

develop for information when claim received.

Podiatry

Operative report

must provide information with claim for specific procedures. Also, must provide records with claim.

Radiology

Radiology report

develop for information when claim received.

Surgery

Operative report

required to submit record for “IC” codes and modifier 25 or we could dev for records at the time claim is received.

Special exam

Operative report, photos, pathology rep

provider told up front to send documentation with claim. If information missing, we dev for information when claim Is received.

Nerve conduction

Nerve conduction study report

provider told up front to send documentation with claim. Deny claim if doc not sent in with the claim.

Physical therapy

Patient record or explanation of what was done.

provider told up front to send documentation with claim.

Visits

Discharge summary, admission sheet, history and physical and progress notes

if critical care, develop when claim received. All other visits, must provide records with claim.

Chiropractic

Office notes

must provide records with claim. Deny claim if doc not sent in with the claim.

All claim types

Explanation of benefits

required for other insurance payment information.

All claim types

Medical records

required to verify history.

Specific specialties

Treatment plans

required to verify treatment.

Durable medical equipment

Certificate of medical necessity

required to verify the service was medically necessary.