Many of our Patients / Customers have requested us in reference of submitting a Health Insurance Claim for the Machine and Supplies bought through PRIMO MEDICAL SUPPLIES. To help our Customers / Patients to use their insurance to their fullest benefit, we have decided to include this page of general instructions for filing an insurance claim on your own behalf for CPAP and BIPAP supplies.
Please Note: Medicare does not allow patients to submit claims on their own behalf. These claims must be billed from a Medical Equipment Company with a Medicare Provider Number.
Please Note: PRIMO MEDICAL SUPPLIES can only provide general instructions for our patients. We cannot determine the policies and procedures for each insurance company and therefore cannot guarantee that this information is accurate for your specific policy. Please verify the following information with your company prior to filing a claim.
General Instructions :-
- Contact the Customer Service or Members Services department of your insurance company directly to ensure that they allow subscribers to submit claims for medical expenses purchased out-of-pocket (such as the CPAP supplies you purchased throughPRIMO MEDICAL SUPPLIES).
- When speaking with the representative from your insurance, ask them on what type of form they require you to submit your claim information. Some companies will allow you to use a generic document called the Health Insurance Claim Form. You can download the form by clicking this link here or can copy paste the URL provided: http://www.usrds.org/forms/08_1500_Health_Insurance_Claim.pdf
Copy of Health Insurance Claim Form - Complete the form required, including the billing and qualifying information used by insurance companies to process claims (See below: HCPCS codes, Diagnosis Codes, and Tax ID number).
- Attach a copy of your invoice from PRIMO MEDICAL SUPPLIES. Supplies ordered on your invoice will need to be split into the appropriate HCPCS billing codes based on your purchases.Example: Our CPAP Masks generally come with a headgear(If you are Purchasing the Mask). Insurance companies process the cost of mask headgear and the mask separately. When you send your invoice you will need to make these separations. As a general rule, the cost of your mask alone is 70% of the total cost you paid, while the headgear is 30% of the total cost. Using this general rule will allow you to split these costs into the correct codes for your insurance company.
- Submit the claim form and invoice to your insurance company in the method they prescribe (most require you to mail; some will allow you to fax along with the Sleep Study Report and Prescription from your Doctor).
- Wait for reimbursement. Generally, insurance companies say they can complete claims within 30 business days. Check with your company for their specific turnaround time.
- Required Billing Codes are provided below:
HCPCS Billing Codes:
The following HCPCS codes are used by insurance companies to process claims. Please use the appropriate code on your claim form to ensure timely processing. Codes should correspond to each separate item on your invoice.
Please Note: Items such as CPAP Wipes, SO Clean 2, CPAP Bed Pillows, Batteries, and DC adapters are not covered as they are considered luxury items.
E1399 - CPAP Miscellaneous (this code is to be used for any CPAP items covered by your insurance but not listed above.
Physician Diagnosis Code :-
Insurance companies require you provide a code associated with your specific Medical Diagnosis. The diagnosis code for Obstructive Sleep Apnea is 327.23. To ensure that you have the correct code for your diagnosis, contact your physician.
Our Company InformationYour insurance company may require information about PRIMO MEDICAL SUPPLIES to process your claim. The most requested information is below:
PRAN MEDICAL LLC
DBA PRIMO MEDICAL SUPPLIES
7515 Grissom Rd Suite 107
San Antonio Texas 78251
Phone: 210-519-5311
Fax: 210-399-3561
Tax ID Number: 46-5629717
Tax ID Number: 46-5629717
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