Does your TPA provide an Injury and Illness Prevention Program (IIPP) ??
What’s a CPT code? CPT codes, or Common Procedural Technology codes are a way for a medical practitioner to assign a set of numbers to any action or service that they provide to a patient. These codes come in the form of five numerals, are maintained by the American Medical Association and updated on a regular basis.
This might seem like a small part of the large medical system but it actually plays a very important role in the insurance industry. When going to the doctor for any sort of medical procedure, the amount the patient owes, the amount the insurance provider owes, and the amount of cuts and reductions that factor into that calculation can get very complicated. Someone called a Medical Insurance Adjuster takes these codes into consideration through the use of specialized software. Action Medical Management uses this software to match the CPT code within a medical bill to a specific fee schedule that applies to the state in which the service was provided. This allows for organization, efficiency and effectiveness in a process that can seem quite convoluted.
However, not every insurance company has a medical insurance adjuster. If that’s the case, matching the right CPT code to the right fee schedule can be complicated. Most states have their own set fee schedules, but some don’t. There are also other levels of discounts provided by PPOs, or Preferred Provider Organizations. That means that knowing what the correct billing appropriation is can be tricky in a lot of cases. For this reason, Action Claim Service has added Action Medical Management. This new service acts as a way for insurance providers to much more easily and efficiently manage the different intricacies of the CPT code system.
With this kind of professional help, CPT codes become a huge help to the industry. Get in touch today if you find yourself with a pile of medical bills, covered in 5-digit codes that don’t seem to point to any sort of consistent billing pattern. At Action Medical Management we’ll help you get it done the right way, in the right amount of time!
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