Author Topic: Universal Contract  (Read 2042 times)

jweiler

  • Newbie
  • *
  • Posts: 1
Universal Contract
« on: April 21, 2016, 05:45:39 PM »
I have a client that says that they are an Urgent Care Clinic but all of their carrier contracts are group contracts not Urgent Care facility contracts.  They said that their previous biller billed using a "universal contract" that allows them to see patients on an Urgent/Emergent basis through that contract in order to be paid even if it is a non-contracted insurance company.  I have a call in to our superintendent of insurance to see if I can gain some insight about this.  I'm kind of thinking that what they meant is that even if you don't have a contract, if the patient feels their problem is emergent and they went to the closest facility regardless of contract status that the patient has a right for care and would therefore be paid based on some sort of statute.  Does anybody have any experience with this?  If so, is there a specific statute that I could append to my urgent claims?  I would appreciate any insight I can get about this.  Thank you very much!

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Universal Contract
« Reply #1 on: April 22, 2016, 05:12:12 PM »
I'm not sure I understand totally.  You said the previous biller "billed using a universal contract".  I'm not sure I understand because contract negotiation is separate from billing.  Are you saying that you believe they should have different reimbursement rates because they are urgent care and that there rates are for regular office services?  I don't believe there is anything to indicate on the claim.  I believe you may need to contact the insurance carriers to ask for contract negotiations.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

kristin

  • Hero Member
  • *****
  • Posts: 703
Re: Universal Contract
« Reply #2 on: April 22, 2016, 10:57:45 PM »
I too am not understanding totally. When a provider/group contracts with insurance, they indicate what type of provider they are, in the contracting process. Urgent Care has a specific taxonomy code in regards to this. Is your client an urgent care facility provider/group, or not? If so, they should be contracted as such.

I have never heard of attaching a statute to a claim, payment is determined by what the POS is on the claim. If they are Urgent Care, that is one POS. If they aren't, that is another.

Medical Billing Forum

Re: Universal Contract
« Reply #2 on: April 22, 2016, 10:57:45 PM »