MODULE 3: PROTOCOLS & ESTIMATES

Submission & Follow-up

Lesson 3.4 - The Billing Blueprint: Mold Edition

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The Billing Blueprint

When to Submit?

Pre-Approval

Submit before work
Know what's approved
Delays start

Post-Clearance

Submit after done
Faster completion
Risk of reductions

Hybrid (Best)

Preliminary before
Final after clearance
Insurance aware + moving

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The Critical Rule

You need clearance documentation
before submitting a final invoice.

No clearance = No proof of completion = No final payment

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Complete Submission Package

Cover letter - claim summary, total amount, doc list
Estimate - organized by sections
Complete protocol - all pages
Amendments - if any
Photo documentation - organized, labeled
Daily logs - equipment, air quality
Clearance letter - ESSENTIAL
Disposal receipts
Signed work authorization

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The Clearance Letter

Property address
Date of testing
Description of areas tested
Testing methods used
Test results
Clear conclusion that area passed

                Include complete clearance report, not just summary letter. If you failed first test, include that too with explanation.
            

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Photo Documentation Organization

Before

Mold extent
Affected areas
Conditions

Containment

Setup complete
Equipment in place
Decon chamber

During

Workers in PPE
Removal process
Bagging

After

Clean surfaces
Ready for clearance
Disposal loaded

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Timeline Must Be Logical

            Work happens → Clearance test → Pass → Containment down → Job ends

            Red flag: Estimate shows work through Jan 15, clearance passed Jan 14

            Clearance happens AFTER work complete, not before.

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Follow-up Timeline

Day 3

Confirm receipt
Get adjuster name

Day 7

Status update
Any questions?

Day 14

Push for timeline
When decision?

Day 21+

Escalate
Ask for supervisor

Document every communication. Date, time, who, what was said.

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Handling Adjuster Questions

"Why this many air scrubbers?" → Show CFM calculation
"Why 7 days?" → Explain timeline: setup, work, clearance
"What is this custom item?" → Specific explanation
"Why priced above guideline?" → Difficult access, protocol spec

                Answer professionally with documentation. Reference protocol. Provide calculations.
            

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Key Takeaways

Hybrid approach: preliminary before, final after clearance
Complete submission package with all documents
Clearance letter is essential - no clearance, no payment
Follow up systematically: Day 3, 7, 14, escalate
Answer questions professionally with documentation

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Coming Up Next

Module 4: Advanced Challenges

Denials and appeals
Limit exhaustion
Complex situations
Working with IEPs

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MODULE 3: PROTOCOLS & ESTIMATES

End of Module 3

Protocols & Estimates Complete

Action Item: Create a submission checklist from what we covered.

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