Billing Checklist for Office Staff

FOR NEW PATIENTS

Must have:

Patient’s First and Last Name

Patient’s address

Patient’s date of birth

Patient’s gender

Nice to have:

Social Security number

Patient’s phone number

Patient’s email address

INSURANCE INFORMATION

Must have:

Insurance name

Billing claims address

Insurance ID #

Insurance group # (if any)

Nice to have:

Insurance phone number

Subscriber’s name

Subscriber’s relationship to the patient

Subscriber’s date of birth

IF WORKERS COMP OR AUTO

Must have:

Insurance name

Billing claims address

Date of Accident

Name of State where injury occurred

Medical Notes – for service provided (must send with claim)

Attorney’s name (if there is one)

Attorney’s address and phone number (if there is one)

Nice to have:

1ST REPORT OF INJURY (always helpful)

Claim number (if already assigned one)

Attorney’s LOP (if obtainable)

INFORMATION REQUIRED ON CHARGE SHEETS

Our Patient Services/Office:

Patient name and date of birth

Date of service

Location of Service

Doctor’s signature on charge sheet

DX codes

CPT codes

FOR CONSULTS – Referring Doctor’s name and NPI #

Authorization number where applicable!

For Established Patients:

Always ask if any changes with insurance or patient address and phone number.