Home Encounter Data Improvement Resources Encounter and claim submissions for practices

Encounter and claim submissions for practices

December 2022

Developed by CMA Physician Services, this is a brief checklist of 10 tasks to prevent and reduce common encounter and claims submission errors. The printable resource will help staff at provider practices learn and or refresh good encounter data submission habits.

Author

California Medical Association Physician Services (CMA PSO)

Why use it

Consistency in doing routine administrative tasks frees up time and energy for patient care. Common errors with provider credentialing and member demographics result in rework, reduced revenue, and may lead to delayed patient care. The Microsoft Word version of this checklist is editable so provider practices and community health centers can update and expand as needed.

Who it’s for

The checklist is intended for front office, business office, billing, and administrative staff at provider practices and community health centers in California serving patients with commercial, Medi-Cal, and Medicare coverage. The checklist is useful for onboarding new staff members. It can also inform semi-annual encounter process reviews, and can be customized to reflect related policies and procedures.

Key take-aways

Complete, accurate, and timely data capture, documentation and coding of encounter data starts with learning and sticking to good encounter data submission habits. Use this checklist to ensure your clinics’ encounters and claims are being submitted appropriately on a daily, annual, and per submission basis.

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

Share This