Insurance Submission and Required Fields Insurances change often so it is very important to send accurate insurance and demographic information with every requisition. This will prevent additional inquiries or possible patient bills that could result if your patient is no longer eligible with the insurance previously submitted. Third Party Insurances require necessary data to properly adjudicate claims submitted on behalf of your patients. Below are the required fields for most insurances. If this data is not being supplied, a missing information report will be created and sent back to your office asking for the information. We please ask that you return all requested missing information back within a week of the request. (See the missing information section included in binder).
DATA FIELD
DEFINITION
Patient Name
Proper spelling of first and last name of patient that appears on their insurance card.
Subscriber Name/DOB
Name & birthdate of person who is the primary holder of the insurance. Usually this is the patient but could be a spouse or parent/guardian. The name of the primary insurance carrier of the patient. If patient also has secondary insurance information, please provide as well with all fields included in this table. (Specify who is primary & secondary).
Primary Insurance Name (Payer)
Insurance ID number
The insurance id of the patient’s insurance. This can be made up of alphas and numbers.
ICD-10 Diagnosis Code
This code is a classification describing the diagnosis from the physician determining the medical necessity for testing. This should always be to the highest specificity, when applicable, as well as meeting limited coverage determinations. (See Medicare coverage update).
Date of Birth
The date of birth of the patient.
Gender
The sex of the patient.
Relationship
Self, spouse or dependent.
Patient Address
The current address of the patient. This should always be updated for accuracy.
Ordering Physician
The physician that is ordering the testing. It is necessary that the ordering physician is PECOS enrolled when submitting Medicare claims. Please refer to CMS website for information. It is also necessary that the ordering physician is State Medicaid enrolled when submitting Medicaid claims. Please refer to State Medicaid website for information. For Worker’s Comp claims, date of injury or date of accident for motor vehicle accidents is necessary for billing.
Date of Injury/Date of Accident
Note: If patient is uninsured and should be billed at DRUGSCAN ® ’s self pay rate, please clearly write “SELF PAY” on the requisition and face sheet. For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
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