Medical Billing Forum

General Category => General Questions => Topic started by: carnilent on July 20, 2009, 05:48:42 AM

Title: fee schedules
Post by: carnilent on July 20, 2009, 05:48:42 AM
How can I obtain the insurance companies' fee schedules?     for united healthcare, blue cross, cigna, and aetna?  I have medicare's already.





   thank you

   carnilent   8)
Title: Re: fee schedules
Post by: PMRNC on July 20, 2009, 07:14:06 AM
If you are participating you would get them from the carrier.
Title: Re: fee schedules
Post by: carnilent on July 20, 2009, 07:19:40 AM
Thanks Linda  ;D
Title: Re: fee schedules
Post by: Pay_My_Claims on July 20, 2009, 10:16:34 AM
How can I obtain the insurance companies' fee schedules?     for united healthcare, blue cross, cigna, and aetna?  I have medicare's already.





   thank you

   carnilent   8)

UHC's and Cigna you can get both online from them (again as linda stated if you are Par)
Title: Re: fee schedules
Post by: PMRNC on July 20, 2009, 11:58:55 AM
I always ask the carrier for the fee schedule associated with the clients contract, that is to be sure the correct fees apply and are according to their geographical location..they CAN be different!
Title: Re: fee schedules
Post by: Pay_My_Claims on July 20, 2009, 12:28:27 PM
I always ask the carrier for the fee schedule associated with the clients contract, that is to be sure the correct fees apply and are according to their geographical location..they CAN be different!

I know, and Cigna and UHC both go according to your tax-id. They look at your contract and load your fee schedule online, or email it to you.
Title: Re: fee schedules
Post by: carnilent on July 20, 2009, 02:25:56 PM
thanks for all your help  ;D
Title: Re: fee schedules
Post by: PMRNC on July 20, 2009, 04:14:03 PM
Quote
I know, and Cigna and UHC both go according to your tax-id. They look at your contract and load your fee schedule online, or email it to you.

Really? I didn't know that. I've never had either one offer to do that when I called!!  :-\ I'm going to have to make a note to ask them to do that.

Today I had something really funny happen. I got an EOB from one of my clients for just a typical 90801, the claim was submitted properly, the charge was $220, and the carrier (PHCNY) not only truncated the amount to $2200.00 but they paid $1650.00  ROFLMAO  The office manager put a little note on it asking me if this was an early xmas bonus.. IF ONLY!
Of course we are sending the check back..  :-\
Title: Re: fee schedules
Post by: Pay_My_Claims on July 20, 2009, 04:38:52 PM
lol, YES check out the website!!!
Is it something in the water??? I have been dealing with BCBS regarding a patient claim dated 12/03/08 we billed out 24,188.00 The claim was split and there was another claim of 3699.00 BCBS had issues with the NU modifier on the e1010 and the e2377. They kept doing something with the claim and they "duplicated it" there was a claim in the system for 48,376.00 Well they paid 36K on the claim!! They had just paid on the smaller one of 3699.000 Regretfully we have to send about 18K back to BCBS :-(
Title: Re: fee schedules
Post by: Michele on July 20, 2009, 08:44:14 PM
I'm surprised that they went that way.  I would have expected you to say they processed it as $2.20!

Michele
Title: Re: fee schedules
Post by: PMRNC on July 21, 2009, 08:00:34 AM
Quote
Is it something in the water??? I have been dealing with BCBS regarding a patient claim dated 12/03/08 we billed out 24,188.00 The claim was split and there was another claim of 3699.00 BCBS had issues with the NU modifier on the e1010 and the e2377. They kept doing something with the claim and they "duplicated it" there was a claim in the system for 48,376.00 Well they paid 36K on the claim!! They had just paid on the smaller one of 3699.000 Regretfully we have to send about 18K back to BCBS :-(

Can't explain the error but I know when i processed DME claims they did have to get split into multiple claims if the claims examiners payment threshold was too low (we used to like those for production.. lol)

But wow to get overpaid by BCBS.. good job.. LOL   ::)
Title: Re: fee schedules
Post by: Pay_My_Claims on July 21, 2009, 08:25:50 AM
Yes we split them because they will hold up a claim over a k0108 or since BCBS doesn't have a complete dme fee schedule they will hold for other codes, so we split our claim. :-)  This was a technical issue on BCBS part for not recognizing the NU modifier!!! I was so tired of calling them about this claim I deserve the extra money..LOL, but I know it has to go back or well you already know.......

Title: Re: fee schedules
Post by: Charles on August 04, 2009, 12:39:57 PM
Does this have any relation to the co-45 or pr 45 in respect to each contract?

Thanks
Title: Re: fee schedules
Post by: Michele on August 04, 2009, 09:06:06 PM
I don't know what you mean by CO-45 or pr 45.  Those sound like Medicare denials.
Title: Re: fee schedules
Post by: Pay_My_Claims on August 04, 2009, 09:34:16 PM
I don't know what you mean by CO-45 or pr 45.  Those sound like Medicare denials.

They are Medicare codes, co =contractual obligation and pr=patient responsibility
Title: Re: fee schedules
Post by: Steve Verno CMBS, CEMCS on August 07, 2009, 04:49:10 PM
If you can't get the fee schedules on line or from the carrier, one thing I did was to create a spreadsheet for each insurance company.  I went over the EOBs and documented the regular allowable amounts. For example, I would look at Aetna's payment EOBs and if I saw 99213 and Aetna allowed $45 on each claim, that was what I entered into the spreadsheet.  Doing this I was able to see a particular insurance company had 145 different allowable amounts for 99214.  I used to use this info when appealing thei UCR when their EOB said they paid 125% of the medicare allowable.  It also helped when they said they didnt pay 100% of our charges and wanted to pay 25%.   I may have had 3,000 accounts with the charges at 100% as the allowable.  But, this is a suggestion only.   

As Sun Tzu once said, in order to defeat your enemy, you have to know your enemy. 
Title: Re: fee schedules
Post by: Pay_My_Claims on August 07, 2009, 07:52:56 PM
We had to do something similar with BCBS of NC since we are non-par and not able to obtain a fee schedule. Also they only have a few DME codes that are on their fee schedule and being custom rehab we have to submit invoices often. Also it depended on what type of BCBS plan you had as far as the allowables were concerned!!