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Billing Tips
Medical Claims
Helpful hints to reduce claims processing time!
- Submit claims electronically. ODS processes electronic claims first each day.
- Verify the patient's relationship to subscriber and plan information is correct before submitting claims.
- Include all pertinent information. Date of birth, subscriber ID, valid CPT and ICD-9 codes.
- If the patient is covered by more than one ODS program, submit one
claim form indicating the name of the subscriber, subscriber ID, employer
(if applicable), and ODS group number for both plans. If covered by
another carrier, indicate the above information plus the name, address
and policy number of the other carrier.
If a patient has primary insurance through another carrier other than ODS, the EOB from that insurance company will need to accompany the claim for consideration of payment. - ODS makes payment twice per month.
- Please contact us before
submitting duplicate claims:
- Re-billing without contacting us slows our turnaround time and delays payment.
- Check Medical Benefit Tracker (MBT) to see the status of a claim. If you haven't registered for this free online service, click here for more information.
- If you receive a PDR indicating that your claim has already been processed before you receive a check, this indicates your re-bill was unnecessary. The claim was processed and is pending for the next scheduled payment date.
- DO NOT USE HIGHLIGHTER ON PAPER CLAIMS.
Reasons For Denied, Paid At a Lower Benefit, or Returned Claims
- Patient is not eligible. A member's card is NOT a guarantee of eligibility.
- Coverage has terminated.
- Claim received with incomplete information. Please remember to include the following:
- Subscriber ID
- Group number
- Date of birth
- CPT Code
- ICD-9 code
- Full name and address of provider with the tax ID number
- No authorization on file for procedure.
- No PCP selected by member.
- Member was seen by specialist for routine services. These must be done by the member's PCP.
- Member was seen by PCP's on call physician and claim did not indicate this. Please indicate by stating on top of claim "ON CALL." This will alert our processors that the physician utilized was on call for member's PCP.
- Member has other primary coverage and EOB was not received with claim.
- Procedure or service is a non-covered service. Please contact customer service to verify if the procedure is a covered service or if any questions.
Electronic Claims and other Transactions
- ODS is very interested in receiving claims electronically.
- The advantages for your office include:
- The claim reaches ODS more quickly, usually anywhere from seconds to 24 hours, depending on connection.
- Lower administrative costs for your office and ODS
- Because electronic claims require consistent, accurate information, the incidence of returning claims to your office is reduced.
- Below is a list of Medical and Hospital Electronic Claims Providers for ODS:
Clearinghouses
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Systems that submit directly to ODS |