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superbill template

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Family Practice Management Superbill Template From the American Academy of Family Practice AAFP Family Practice Management Toolkit http //www. aafp*org/fpm/20060900/43inse. html Waiver l Insurance Subscriber name Group Copay Account Physician name Date of service Patient name Address Phone DOB RANK Age Sex Office visit Minimal Problem focused Expanded problem focused Detailed Comprehensive Significant separate service Well visit 1y 1-4 y 5-11 y 12-17 y 18-39 y 40-64 y 65 y Medicare preventive...
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Who needs a Superbill Template?

The Superbill Template is used by the healthcare providers to control the medical services provided to the patients. This template is issued by the American Academy of Family Practice and is used by the Department of Family Medicine. It means that template is applicable for each family member.

What is the purpose of the Superbill Template?

The main purpose of this template is to create a healthcare claim. The insurance company receives the completed superbill and makes the decision as for reimbursement. That’s why it is very important to add all the essential details to the form.

What other documents should accompany the Superbill Template?

The Superbill is usually accompanied by medical prescriptions, pay stubs, copies of medical cards and other supporting documents.

How long does it take to fill the Superbill Template out?

The healthcare provider can use this form for a certain period of time depending on patient condition. That’s why there is no due date for the Superbill and no estimated time for completing it.

What information should be provided in the Superbill Template?

The health care provider has to add the following details:

  • Information about the patient: name, phone, date of birth, address, age, sex
  • Insurance details
  • Physician name
  • Information about the visit
  • Details of preventive services
  • Radiology services
  • Office procedures
  • Skin procedures
  • Laboratory procedures
  • Information about the vaccines
  • Information about the medications

The physician also has to sign the form.

The second page contains the diagnosis codes.

What should I do with the Superbill Template after its completion?

The completed Superbill is forwarded to the insurance company or whoever needs it.

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