Request Health Coverage Proposal
If you want a marketing report/proposal, the following elements for each report are required to fulfill the request.
Accessibility Report
Data must be in MS Excel format
- Zip codes of employees (from census)
- Access standards from the client
Sample format
Disruption Analysis
Data must be in MS Excel format
- TIN#'s
- Providers' names (please separate the first and last names)
- Providers' addresses (street, city, state and zip)
Sample format
Claims Repricing
- Claim Type (HCFA/UB) * (Required)
- Bill Type (for institutional claims)
- Provider TIN
- Provider Organization Name
- Rendering Provider Last Name (for Professional claims)
- Rendering Provider First Name (for Professional Claims and must be in separate column from Last Name)
- Provider Address
- Provider City
- Provider State
- Provider Zip
- Number of Days for Service (required for inpatient institutional claims)
- Place of service (required for Professional Claims)
- Revenue Code (for institutional claims)
- HCPCS Code (required for professional claims and if present on institutional claims)
- DRG Number
- Units of Service
- Charges
- Allowed Amount (required for WC)
- Modifier (if present on the claim)
- No punctuation in headers
- Excel Format (dates should be expressed as MM/DD/YYYY)
- Although it is not required, it would be helpful to have both service and billing addresses for providers so we can determine the best and most accurate provider match