Jul 7, 2011 | Medical billing basics
Pregnancy PCP’s or obstetricians are required to notify SHP of the first prenatal visit and/or positive pregnancy test within two (2) working days by completing the Pregnancy Notification Form (refer to the Forms Section), whether the pregnancy was identified through...
Jul 6, 2011 | Medical billing basics
A medical billing business requires efficient software to be able to perform tasks related to medical insurance and benefits. There are several billing software available in the internet today, finding the right one, however, can be challenging. Below are...
Jul 5, 2011 | Medical billing basics
Requests for a Second Medical Opinion Second Opinion is a consultation by a physician other than the member’s Primary Care Physician, whose specialty is appropriate to the need, and whose services are obtained when the member disputes the appropriateness or necessity...
Jul 2, 2011 | Medical billing basics
Emergency Services Emergency services are not subject to prior authorization requirements and are available to our members 24 hours a day, seven days a week, 365 days a year. An emergency medical condition is a medical condition manifesting itself by acute symptoms of...
Jun 30, 2011 | Medical billing basics
All of the following procedures and services require Prior Plan Notification and must be provided in a SHP participating facility*: o Inpatient and Observation Admissions, as noted above o Admission to any rehabilitation and skilled nursing facility o All surgical...
Jun 29, 2011 | Medical billing basics
Incentive plans for medical billers are effective but it does not necessarily mean that it has to be expensive for it to work. There are more affordable options, which are as effective in inspiring and motivating medical billers. There are things you can...
Jun 27, 2011 | Medical billing basics
Prior Authorizations: Prior authorization (pre-service requests) allows for the use of quality, cost-efficient covered health care services and helps to ensure that effective transition of care planning is done so that members receive the most appropriate level of...
Jun 25, 2011 | Medical billing basics
The need for well-experienced professionals in the health and medical industry increases every single day. The reason behind this is that the Healthcare industry is so large and it covers an extensive area of technological equipment and procedures. In...
Jun 24, 2011 | Medical billing basics
Referrals or Prior Notifications A referral or prior notification is a request by a PCP or a participating specialist for a member to be evaluated and/or treated by a participating specialty physician and/or facility. SHP uses two types of forms and processes: 1....
Jun 22, 2011 | Medical billing basics
Children Medical Services (CMS) Children with special health care needs are those children under age 21 whose serious or chronic physical or developmental conditions require extensive preventive and maintenance care beyond that required by typically healthy children....
