Superbill

A 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

Some insurance companies require a provider signature, while others will process billing without a signature^{[citation needed]}
All required fields should be completed (with the exception of those that are considered optional)
Provided information should be readable
CPT and ICD-10 codes should be marked clearly
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.)
Only generally accepted medical terminology and abbreviations are allowed ^{[citation needed]}