Medical Billing Forum
General Category => General Questions => : lynnloving1 April 17, 2013, 06:18:55 PM
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I am brand spanking new to medical billings. Unfortunately, the person who was to train me quit before she could.
I am following up on a couple claims and the claims were denied because of "We are unable to consider this claim due to the lack of pricing information from the PPO network. The provider must submit this claim directly to the PPO network so that they can pre-price the claim and file the claim with cigna healthcare"
So, I called Cigna and they said I need to send the claim to Allegiance at p.o. box 3018, Missoula, MT 59801. How would I know to do this? I don't see any cards in the pt chart.
Now, how do I proceed from here? I have the address buy don't know if I print off a HCFA or find their phone number and just call them or what?
Thank you in advance for any assistance.
Blessings,
Lynn
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So, I called Cigna and they said I need to send the claim to Allegiance at p.o. box 3018, Missoula, MT 59801. How would I know to do this? I don't see any cards in the pt chart.
This is why you will want to implement some sort of policy to verify benefits. Sounds like this patient has a plan where a TPA is involved. If benefits were verified one of the big questions asked is "Where do we send claims" :)
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I agree with Linda. Our policy is when a patient calls our office and/or we receive a referral from other provider, we get all of their demographics and insurance information over the phone and we tell them we contact insurance first and get benefits and any possible authorizations. when you contact the insurance for the specific benefits for your office, you ask them all the questions you need to ask. Just remember to document persons name, time, and all information given to you including a phone call reference#.
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ooh, also when you ask where to send claims, get the address and also ask if they have a payor id# (for electronic submissions)
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And make sure you mention your specialty (if any). The place to send chiropractic claims (just a for instance) is completely different, address and electronic.