Health Insurance Billing Requirements

Health insurance billing requirements provide the guidelines for information needed to successfully process a claim with an insurance company. The regulations also cover federal laws on patient privacy and confidentiality and what procedures medical personnel must follow to prevent this information from being compromised during the billing process.

National Provider Identifier Number

• As of 2007, practitioners that bill health insurance companies are required to present an individual National Provider Identifier (NPI) number along with each claim. This allows insurance companies to maintain one standard for doctor and claim identification that speeds up the verification process. It also protects the security of electronically transmitted information ensuring that no one intercepting the transmission will be able to decipher patient, insurance or doctor information.

Privacy Restrictions

• HIPAA regulations restrict the information insurance companies may view with regard to medical billing. Insurance providers may only view patient records to make decisions regarding covered care and the limits of a particular person's insurance policy. As of 2007, all insurance claims, regardless of HIPAA status are required to be submitted on forms produced by the Health Care Financing Administration and the physician's NPI number must be affixed to the document for all referrals.

Proof of Insurance

• At the time of your visit to the the hospital or doctor's office, you are required to provide proof of insurance to medical staff. An insurance card of some kind and a state issued picture ID generally suffice. Your health insurance card must have your policy number displayed on it. This number will be necessary for your claim to be processed correctly. Before returning your card to you, medical staff are required to make a photocopy of it for billing and filing purposes.

Deductibles and Co-Pays

• You are required to pay all co-pays and deductibles if any exist at the time of your medical treatment, in accordance with doctor billing policies. Your particular co-pay or deductible can be determined by contacting your insurance provider and may even be displayed on your insurance card. Your health insurance company is then obligated to provide you with an explanation of benefits detailing how much the company has paid out.