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Question: Patients in my practice are covered by a few different insurance carriers, and of course their policies differ on which procedures they’ll cover. Is there any way to find out this kind of information without calling each payer every single time I’m preparing a claim?

Ohio Subscriber

Answer: Most payers have sections of their websites dedicated to information that is helpful or necessary for providers. Once you’re in the provider section, you can utilize the search bar or look at the categories of documents available. Although many payers have portals for providers to utilize, many also make their coverage policies and guidelines available without a login.

For example, Excellus BCBS has listed where you can find the payer’s guidelines for different conditions or situations, along with relevant procedure codes. Cigna has >coverage policies available, too. You can look for your specific payer’s policies on their website. As you gain experience figuring out which search terms are effective for accessing the information you need, the search process should become more efficient.

If you can’t find the information you need, you may need to contact the payer and try and talk to a representative. It’s worth trying to cultivate a friendly professional relationship with individuals who work with different payers so you know you have someone you can contact with a specific question and (hopefully) get an answer more easily and quickly than, for example, having to navigate an automated phone system.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC