Overview of Claims within Doulado
Navigating the claims process can be complex, but using Doulado is a step towards simplifying it to ensure a smooth and efficient experience. Whether you're new to submitting a claim for doula services, or have been doing it for awhile, Doulado’s intuitive system makes the process seamless.
It is important to remember the insurance landscape for doula services is still evolving. Coverage and reimbursement practices can vary significantly between different insurers and states. This variability means that success in claims reimbursement, unfortunately, isn’t guaranteed—even with meticulous billing and claims management. Doulado's support team can offer basic guidance, but it is the doulas' responsibility to understand and adhere to the specific requirements of each payer!
In order to turn on the claims processing feature, we do require an annual subscription to a Team or Impact plan. Our Team and Impact plan subscribers sign a Business Associate Agreement (BAA) with us where we both officially accept responsibility to protect private health information, which is needed to be able to submit claims to insurance companies. Even as a solo provider, a team plan is required for for HIPPA Compliance, which allows you the ability to add other team members to your account to collaborate with doula partners or backups easily.
Additionally, there is a $1 fee per claim submitted through Doulado that is billed to your account monthly. This fee covers the cost of using the clearinghouse to submit claims.
Within this article, as well as the attached linked articles below, we’ll walk you through the key steps involved in submitting a claim through Doulado, from getting credentialed and setup with your payers, understanding a CMS 1500 form, to tracking claim progress. By understanding the process and flow of a claim in Doulado, you can ensure accuracy, avoid delays, and maximize your reimbursement. In the video below, there is a brief demonstration of starting a claim in Doulado as well as how to track statuses, notices and keep track of your payments!
This roadmap below identifies the journey a claim takes as it is electronically submitted through Doulado. We work with a clearinghouse, which is a third-party organization that processes and transmits insurance claims between doulas (or other healthcare providers) and insurance companies. The clearinghouse acts as a middleman, ensuring that claims are formatted correctly, checking for required fields, detecting superficial errors, and then submitting them to the appropriate insurance payer for reimbursement. It helps streamline the billing process, reduce claim rejections, and improve payment turnaround time. Once the claim information is cleared through the clearinghouse, it is then sent to the payer to complete the process!
Unless you have ERA (Electronic Remittance Advice) setup, the next information you would hear about your claim would be directly from the insurance payer, whether via the mail or through their provider portal.
You can navigate to the Billing section of your Doulado account to access the steps to turn on the claims processing feature. Once you have an active annual Team subscription, review and sign a BAA and Claim agreement, and reviewed this training article, then you should be ready to submit a claim through Doulado!
Occasionally, some payers may require enrollment paperwork to submit claims to them through Doulado. This is one extra step that is automatically initiated once you submit your first claim to that payer, and is basically the payer verifying that you will be submitting claims through Doulado to them now. Doulado support will reach out with enrollment paperwork and instructions on that payers' process. This enrollment paperwork is only required by some payers, and is only done with the first claim to them!
Recommended steps in getting ready to submit claims as a Doula:
- Register for your NPI number
- Research Medicaid payers in your area, or private insurance companies your clients may have to learn more about their doula coverage
- Start the credentialing process with a payer (We recommend getting established with 1 payer first to go through the whole process, rather than multiple at once.)
- Complete the contracting process (if necessary with that payer)
- Register for their provider portal in order to easily find additional information and view EOBs (if the provider has a portal)
- Review the payer's claim requirements including their CPT codes, modifiers or other specific information they require
- Submit your first claim!
Please review these other claim related articles to further understand the process of doulas submitting claims through Doulado:
Reach out to support@doulado.co with any further questions!