# Peer Support Billing Checklist

Free educational pre-claim checklist from Peerakeet. It does not determine
coverage, replace official payer instructions, or guarantee payment. Complete
each item using the rule effective for the exact state, payer, benefit,
provider, service, and date.

## Authority and version

- [ ] State, payer, benefit, program, provider type, and service are identified.
- [ ] Official source links, effective dates, review date, and rule owner are recorded.
- [ ] No newer manual, bulletin, fee schedule, contract, or code-set update applies.

## Participant and coverage

- [ ] Participant identity and member ID match the payer record.
- [ ] Eligibility is confirmed for the date of service and correct plan.
- [ ] The exact peer service is covered for the population and setting.
- [ ] Coordination-of-benefits requirements are resolved.
- [ ] Required referral, order, assessment, or plan of care is current.
- [ ] Required authorization covers provider, service, dates, units, and modality.

## Organization and workforce

- [ ] Billing provider enrollment, contract, NPI, taxonomy, location, and revalidation are active.
- [ ] Rendering peer enrollment or affiliation is active when required.
- [ ] Peer certification, training, background checks, and state scope are current.
- [ ] Required supervisor qualifications, assignment, cadence, and documentation are current.

## Service and documentation

- [ ] The activity fits the covered service definition and participant's required goal.
- [ ] Actual date, start/end time, eligible duration, breaks, location, and modality are recorded.
- [ ] Individual or group setting, attendance, staffing, and participant-specific evidence are complete.
- [ ] Peer support provided, participant response, progress or barrier, and plan are specific.
- [ ] Note language stays within the peer role and distinguishes reported from observed information.
- [ ] Required signatures, credentials, dates, reviews, and amendment history are complete.
- [ ] Required service, telehealth, privacy, consent, and disclosure conditions are satisfied.
- [ ] No incompatible service, participant, or practitioner time overlap is unresolved.

## Claim

- [ ] Correct claim type, payer ID, and billing workflow are selected.
- [ ] Billing and rendering provider fields match payer enrollment.
- [ ] Diagnosis comes from an authorized source and meets the applicable rule.
- [ ] Code and every modifier are valid for the service and date.
- [ ] Place of service matches documented participant and practitioner locations.
- [ ] Units match eligible time and the payer's written calculation method.
- [ ] Authorization, benefit, group, daily, annual, and NCCI limits are satisfied.
- [ ] Charge matches the organization's approved current fee or contract configuration.
- [ ] Original-claim reference, frequency code, attachments, and filing data are present when required.
- [ ] Claim is within the timely-filing deadline.
- [ ] An authorized organization reviewer approved the exact claim contents.

## After submission

- [ ] Original payload and submission timestamp are retained.
- [ ] Clearinghouse and payer acknowledgments are linked to the claim.
- [ ] Pending, rejected, denied, adjusted, and paid outcomes have an owner and deadline.
- [ ] ERA Group Code, CARC, RARC, units, allowed amount, and paid amount are reconciled.
- [ ] Corrections, replacements, voids, reconsiderations, and appeals preserve a full audit trail.
- [ ] Root causes update training or workflow only after authoritative review.

Source page: https://peerakeet.com/billing-resources/billing-checklist