The world of medical billing has developed immensely over the years. In the years before, you would go see your doctor, have your treatment, for whatever the case may be, receive your bill, submit your check or give the doctor cash and that was the end of it. Certainly, if you had insurance, which back in those days was very uncommon, the doctor would then send a paper bill to the insurance carrier, whether it is a private carrier, Medicare or Medicaid. Everyone knows how simple it is to lose paper. Anyway, the stone ages are long behind us. True, some doctors still live in the stone ages, but the majority has entered the modern age along with the rest of the world and has begun to make use of what is known as electronic medical billing.
Comprehending exactly how electronic billing works is really not trivial at all. Having full grasp on what is actually involved with the entire process is a totally different story altogether. As a result, this information will be as simple as possible so that you will have a basic understanding the next occasion you have to go to the doctor for medical services.
Electronic billing is billing without the use of paper. The bill that is printed out and given to you by the doctor or provider, for instance with a clinic, is then entered into the computer with a lot of information which covers just about everything including who your insurance carrier is, this is the most essential piece of information. Without that piece of information, the insurance provider would not know how to process the claim so that the doctor or clinic gets paid. After entering the information into the computer, with the use of a specialized medical billing software program, the information is then electronically submitted to the carrier by means of a modem.
A modem is a device that utilizes your phone line to transmit information, which shares similarity to a fax machine. The difference between the fax machine and electronic billing is that with a fax machine a piece of paper is placed into the machine, a copy of it is electronically made and passed along the phone line to another fax machine which prints out a copy of the paper on the other end. On the other hand, electronic billing, there is no paper at all. The information is typed into the computer and then the software itself takes that data and transmits it over the modem to the carrier.
For the carrier to be able to read the information, it has to be sent in a particular format called NSF format. This format is standard for every carrier. With all that said, a special program has to be made for every carrier due to the fact that even though the format is standard, not every carrier utilizes every field in the format. Because of this, if certain fields are transmitted that the carrier does not put to use, it is possible they will reject the claim. However, that is another problem completely.