Your benefits are decided by your employer selected by you during enrollment. The Information obtained by FMBS is provided by contacting your plan’s provider relation department and are details of your plan benefits.
It is the responsibility of the policyholder and covered parties of the policy to know and understand their benefits. Benefit Verifications, Patient Responsibility Amounts, and Authorization are not a guarantee of payment. Patient Responsibility provided is an estimate of cost and does not replace any contracts or amounts requested by your provider.
FMBS does not guarantee medical cover nor insurance reimbursement. FMBS does guarantee that all efforts will be exhausted to ensure your claim was processed at its highest level of benefit.
Your chosen provider may be considered an out of network provider. For clients that hold HMO policies, reimbursement will not be obtained, as HMO policies do not support out of network providers.
Billed Charge Amount: Due to auditing regulations, FMBS, as a billing company, is required to attain a set billing schedule based on national rates. These rates may differ from the provider’s charging schedule FMBS represent.
Client agrees to designate a compliance officer to address compliance concerns quickly and effectively with FMBS, and to timely cooperate with FMBS in audits, investigations, corrective actions, reporting to ensure compliance with payer policies and applicable laws and regulations
Authorizations are not a guarantee of claim payment.
It is the responsibility of the policy holder and those covered by the plan to know and understand their benefits and all Authorization & Referral requirements.
*Authorizations and Gap Requests take a minimum of 21 business days to receive a response from your insurance plan. Please make sure you have allotted the correct amount of time for auth submission, response and appeal.
BILLING SERVICES AGREEMENT
The following Summary of Terms is qualified by reference to the entire Agreement that follows.
The Client has selected the following Service Option(s) for healthcare billing and collection services with FMBS: Option_____. Any additional services the Client adds in the future outside of the Options listed, such as credentialing, consulting, etc., are separate fee for service.
Option One: Direct Provider Referral – For Patient Use Only
o Limited provider/client assistance outside of specific claim submission
o Provider ONLY Practice
o Provider and Facility claim submission at the rate of $200.00 for both mom and infant claim
Option Two: Provider Single Claim Submission
Option Three: Account Management
This service is offered at a rate of:
o Claims List Report
o Applied Payments Report
o Transaction Summary Report
Option Four: Consulting Care
This service is provided to assist in Practice/Provider needs, which includes, but are not limited to:
* A Superbill is a standardized, detailed invoice itemizing all services provided to a patient. It is given directly to patients as a receipt after the patient has paid for Client/provider services, for example when the provider does not accept insurance or the provider is out of network. The patient has the option of submitting the Superbill to their own payer (insurance, funds, programs) for reimbursement.
Personal cell phone (provider use only): 602-821-1594
FMBS shall be compensated as follows for its services: