Medical Billing Forum
Billing => Billing => Topic started by: Mnelson88 on March 16, 2016, 02:23:58 PM
Is anyone familiar with this whole new medical necessity review for CIGNA patients through ASH??
We are out of network with both CIGNA and ASH and our MNRs are being denied by ash saying that we need to be in network with ASH even though the patients have out of network benefits with cigna. Also when I call ASH hey say for physical therapy the provider has to be specialty licensed as a PT to do PT, and my provider is a DO but hes within the scope of his license to do pt..so im so confused.. :-[
We have a DO that bills for PT as well but we haven't run into this particular situation. But we have had similar situations. When you verify benefits you must make sure you specify that the provider is a DO and ask specifically what are the benefits for a DO doing PT. I would call CIGNA and ask them about the OON benefits and if they apply to this.
I'm just going to put this bluntly - ASH sucks! I worked in Chiropractic/Physical Therapy for 5 years and ASH/Cigna was by far the biggest pain in everyones rear end. You verify that the patient has so many visits for Chiro/PT per year, send your claims to ASH for repricing/review. After the 3rd or 5th visit, ASH starts requesting records to review medical necessity. You fax the soap notes, pt notes, etc to ASH at the requested number......call back a couple of days or weeks later to check on the claim, or you get an outright denial on the claim....."oh, ASH states that they never received your records or they weren't received in a timely manner".
ASH is a never ending nightmare --- to the point that we quit accepting Cigna patients or they had to be self pay for any and all Chiro/PT services. If they wanted to file a claim themselves, we would give them copies of everything at the end of treatment or every few weeks, but we did not file any Cigna/ASH patients.
Good Luck --
I second Jennifer's response, they are a total nightmare. I personally have never dealt with them, but I have a friend who bills chiro, and all she did was go around in circles with ASH. Eventually, she had the chiro withdraw from Cigna, just to end the craziness.
ASH sent out a letter about a year ago asking my podiatry practice to join them, and I told my doctor absolutely not. They are the devil. >:(