Cigna and 3rd party processing (Data iSight)

[gmcfnyc]

Hi there-

We're a chiropractic provider out of network with Cigna. We've never had a problem with payments in our 20+ years of submitting and receiving with Cigna until this past June when- all of the sudden- we started to receive EOBs with claims being processed by Data iSight at a much lower payment rate. Select Cigna patients were going from usual and customary to significantly less with the explanation:

"Health Care Professional: patient is not liable if you accept the allowable amount. Contact Data iSight at 877-489-5984 before billing the patient."

Since we received them I have called Data iSight to appeal each patients payment. I was told Data iSight would follow up in 3-5 days. A supervisor called asking if we accept that payment- we said no and would like to send it back for reprocessing directly by Cigna. They said allow 30-45 business days. 45 business days later I call back and they said that all of our claims were NEVER sent back to Cigna and that each of these claims are closed with no further adjustments to be made. 

I have been back and forth with Cigna and Data iSight- which of course neither one wants to deal with or help with. I'm just being bounced from one to the other. Not sure how this is even legal.

Anybody else dealing with this? What do we need to do to solve this frustrating issue? Thanks much for any help.

[PMRNC]

If these are group health plans I'd get the patient involved using ERISA.
Sounds like they are using a Re-pricing company and somehow have you as "participating". Again, get the patient involved if these are ERISA claims. If you want to appeal I suggest getting the patient to sign an Authorization form for you, and a copy of their summary plan information and then APPEAL USING ERISA (DOL)