Rabies Immune Globulin (RIG), Human CPT Code 90375: Infectious Disease Billing Guide

A clearinghouse acts as an intermediary between a healthcare practice and payers during electronic claim submission. It can check claims for formatting or data issues, apply payer-specific routing, and return rejection information before or after transmission. A clearinghouse does not replace documentation, coding review, eligibility work, authorization, payer follow-up, or payment reconciliation; those remain part of the practice’s broader billing workflow.

Supporting documentation should clearly connect the patient encounter, medical necessity, administration, and the billed drug service. Practices should maintain records that substantiate the clinical reason for treatment, the product provided, administration details, and the responsible clinician’s documentation. Exact payer requirements can differ, so the workflow should include a review of applicable payer policies and the practice’s own documentation standards before submission.

The review should confirm active coverage, benefits, network considerations, and whether the treatment is handled under a medical or pharmacy benefit. Practices should also determine whether authorization or other payer approval is required before the service or drug is provided. Recording the request, supporting documentation, payer response, and claim connection helps reduce avoidable delays and makes unresolved authorization issues easier to track.

Denials may result from missing or inconsistent documentation, absent authorization, incorrect benefit routing, coding or unit issues, charge-capture gaps, or payer-specific claim edits. A useful denial process groups each outcome by root cause rather than treating every denial as isolated. Reviewing trends across claims can reveal whether the underlying issue belongs to clinical documentation, front-office verification, coding, submission, or payer follow-up.

Payment review compares the submitted service, applicable contract or fee schedule terms, payer adjudication, and posted payment details. The review should consider the drug, administration, and any related evaluation and management services as appropriate to the claim. Short-pays, incorrect fee schedule application, unit mismatches, and other discrepancies can then be documented, disputed, and tracked through resolution.

Revenue-cycle management can cover the workflow from referral and documentation through eligibility, authorization, charge capture, coding, claim submission, rejection handling, denials, payment posting, underpayment review, and accounts-receivable follow-up. For infectious disease practices, the process may also need to account for drug and infusion services, OPAT workflows, hospital-related arrangements, and the distinction between clinical work and its financial support.

Start by mapping where revenue can be lost before, during, and after submission. Review documentation, charge capture, authorization, benefit routing, coding, claim edits, payment posting, and aging follow-up. Reporting by payer, provider, service line, denial reason, and claim status can help connect a missed or delayed payment to its operational source and support targeted workflow changes.

Reporting is useful whenever leaders need visibility into claim volume, payer behavior, denial patterns, payment trends, or aging balances. It can support workflow review even when a practice is not experiencing an obvious billing crisis. The most useful reports connect financial outcomes with operational steps, helping teams determine whether a problem begins with documentation, authorization, coding, submission, contract application, or follow-up.