Starting with insurance.

Decide first

Taking insurance changes who pays you, how fast, and how much of your office’s week goes to paperwork. If you have not decided yet, two earlier guides test the decision with your own numbers: should your cash-pay practice accept insurance? and can you accept insurance without hiring a biller? The guides below assume you have decided to start, with one payer or several.

Four things before the first claim pays

1. Enrollment with each payer. Your provider’s identity, credentialing, a signed contract with an effective date, and then the setup that lets claims, remittances and payments move electronically. Read: payer enrollment for a chiropractic practice.
2. A fee schedule. One set of charges for every payer and patient, set so that no payer allows more than you charge, with cash discounts kept inside the rules. Read: setting your fee schedule.
3. A coverage check at intake. Active coverage, the chiropractic benefit, visits left, authorizations and who manages the benefit, checked before the visit rather than discovered on a denial. Read: check chiropractic coverage before the visit.
4. Claims built the way payers expect. The right identifiers, the CMT code that matches the note, diagnoses in order and the modifiers and dates each payer requires. Read: what a clean chiropractic claim needs.

Start the slow step first

Enrollment is the long pole. Each payer works through its own queue, and you cannot speed most of it up. So start enrollment with every payer you plan to take on the same week, and build the other three pieces while you wait: your fee schedule, your intake checklist and a test of your claim setup on the first few visits.

Until a payer confirms your effective date, its members are out-of-network patients at your practice. Tell them so before the visit, not after. Patients who will pay for themselves are owed a good faith estimate of the cost; the guide to setting your fee schedule covers when.

Who owns each piece

A new insurance practice runs into trouble when everyone assumes someone else has a task. Put a name next to each one before the first insured visit:

• Enrollment tracking: whoever will chase each payer every couple of weeks until the contract and effective date arrive.
• Coverage checks: the front desk, at scheduling and again before the first visit.
• The signed note and the codes it supports: your provider, every time.
• Claims, remittances and payments: whoever does your billing, whether that is your staff or a service. The Choosing how to bill guides help you decide who.

Where Claims Native fits

Claims Native is a billing service for chiropractic practices, starting with BCBS commercial plans. Once a payer has your provider on file, we set up enrollment with the clearinghouse and the payer so claims and remittances can flow. That takes weeks, and the payer sets the pace; we chase it and tell you where it stands. We check the patient’s coverage before we file, so a coverage problem shows up before the claim goes out, and we check each CMT claim against the signed note. See how we start.