Superbill

Superbill is an itemized form used by healthcare providers for reflecting rendered services. Superbill is the main data source for creation of healthcare claim, which will be submitted to payers (insurances, funds, programs) for reimbursement. Although the superbill form is not unified, and it is created/modified depending on healthcare provider specialty, type of rendered services, additional requirements, as well as ease of handling, there is a set of obligatory attributes, relevant to all superbill types.

Superbill form consists of 4 main parts, containing mandatory fields to be completed for accurate claim creation:

Provider Information

Rendering Provider

• Last/First name and Degree
• Service location
• Signature

Ordering/referring/attending physician

• Last/First name and Degree
• NPI (National Provider Identifier)
• Referring provider NPI should not be blanked.

Patient Information

• Patient’s first and last name
• Patient DOB
• Insurance information (Insurance name/and ID)
• Date of first symptom (upon necessity)
• Last date seen (upon necessity)

Visit information

• Date of service
• Procedure codes (CPT) – list of commonly used codes by medical provider according to the provider specialty
• Diagnosis codes (ICD-10) – list of commonly used codes by medical provider according to the provider specialty
• Modifiers (Location and conditions modifiers)
• Time (for timed codes)
• Units
• Quantity for drugs
• Authorization information (if applicable)

Additional information

• Notes and comments (for e.g.: PT cap)

Superbill utilization rules

1. Some insurance companies require a provider signature, while others will process billing without a signature
2. All required fields should be completed (with the exception of those that are considered optional)
3. Provided information should be readable
4. CPT and ICD-10 codes should be marked clearly
5. In case if required CPT or ICD-10 code could not be found in the given list, Provider should give legible handwritten description of service/diagnosis, along with additional information (units, time, type, etc.)
6. Only generally accepted medical terminology and abbreviations are allowed

Further reading

• The Superbill-Guide to a Uniform Billing and-Or Claims System(ISBN 0685033295)by Medical Group Management Association Staff, Costello, William E.