Medical Billing Forum

General Category => General Questions => Topic started by: ste on May 02, 2010, 03:07:52 PM

Title: Tax ID numbers
Post by: ste on May 02, 2010, 03:07:52 PM
I bill for a provider that has 5 or 6 patients covered by a specific insurance company. Claims for one of these patients are denied because the tax ID no. I am using (the one and only one I use for this provider) has been canceled and the provider has another one in use. The provider has no recollection of ever using another tax ID number. The insurance company will not tell me what the new Tax ID number is because it is a HIPAA violation, and they are reluctant to give me any information about the new number. Other patients with the same insurance are unaffected. From my perspective it seems like a problem the provider needs to work out with the insurance company. However, the provider gives me the “this is what I am paying you to do” or the “don’t bog me down with paperwork” routine. Any suggestions on how I should cautiously tread to solve this problem?
Steve   
Title: Re: Tax ID numbers
Post by: Michele on May 02, 2010, 08:00:45 PM
I would call the insurance carrier with the eob of the denial due to the tax ID#, and an eob from the same carrier for a patient that got paid.  When they say that the claim was denied due to the provider's tax ID, then I would provide them with the paid claim information and ask why that claim was paid since it had the same info on it.  Also, regarding HIPAA, you are not asking for anything regarding PHI, you are asking about the provider file for the provider you are working for.  I know they won't give you the EIN, but they should be able to explain why/when the info changed from the info you are providing them with.

Michele
Title: Re: Tax ID numbers
Post by: dekenn on May 03, 2010, 12:25:35 PM
Also, if it happens to be a secondary claim, it might be coming over (such as from medicare) with a different id number.  that's the problem I'm having.  Medicare uses his ssn, but all insurance companies have ein as id number. i'm in the process of correcting it (i think!), but i have one insurance company that repeatedly denies the claim when it comes with the other number, even though we have called and requested that they link the two together.
Title: Re: Tax ID numbers
Post by: PMRNC on May 04, 2010, 06:27:57 AM
The insurance company cannot and will not provide information on the EIN, it's an IRS violation and yes it is a HIPAA violation as well. What I would do is contact the IRS and yes the provider is going to have to get his hands dirty with this. Just explain this EIN was in existence prior to you taking over and he needs to get this taken care of with them. Deactivate the prior one if not being used and then you will need a W9 to the carriers to make sure the proper EIN is linked.
Title: Re: Tax ID numbers
Post by: Lisa@srts-inc.com on May 05, 2010, 08:09:48 AM
I have had this happen a few times, especially when the NPI's took effect.  One situation I was able to get the info from the insurance company when I gave them my client's ss# and date of birth, if that doesn't work your client will have to call,  but I would get every detail you could for them ahead of time.....the phone #, all the prompts they will need, all the patient info and exactly what they need to ask........make it as simple as possible.
Title: Re: Tax ID numbers
Post by: ste on May 11, 2010, 08:29:54 PM
Given all the interesting replies I’ll continue the story.
First thing Monday morning with two different EOB’s in front of me (as Michele advised) I called the carrier. The conversation focused on why the claim was denied. The rep talked about a contract expiring in 2008, so a different EIN in existence since 2004 was designated as the appropriate one to use. As with previous calls the rep insisted all I had to do was use the new EIN and the claims would be paid. I said, “How can I use an EIN neither you nor the physician will give me?” The rep then calmly gave it to me. I was stunned and couldn’t think of anything to say. Unfortunately, the conversation ended without discussing the second EOB and the reasons why it was accepted.
Feeling falsely pleased that I had a solution I notified the physician saying only that I was given the EIN and would resubmit the claims and had resolved the situation. I then resubmitted the claims with the other EIN and continued on with the morning.
An hour or two had passed when a message arrived from the provider asking me to specify the EIN and to hold off on resubmitting claims. I quickly coughed up the EIN and hit reply. I then scurried into the billing software and into the awaiting batch section, but it was too late. The claims were already being scrubbed. No longer feeling pleased I notified the physician that the claims had already been submitted.
The message from the physician included, “I need to make sure the tax ID number is legitimate”. How would one go about doing this? Since a physician has to apply for a tax ID number shouldn’t he know by looking at it if it is legitimate or not? Is there anything I should do at my end? (Other than next time make sure I listen and follow through with Michele’s advise).       
Title: Re: Tax ID numbers
Post by: Michele on May 12, 2010, 07:35:13 AM
Well, if the physician has worked for other offices the tax ID, EIN could have been for another provider/group that he/she may not have recognized off the top of his head.  I'm sure you already know this now, but never submit a claim using a tax ID/EIN that the provider did not give you or at least verify.  Payment under that EIN may go anywhere.  They shouldn't have given you the EIN over the phone, but they should have dug deeper as to why the one expired in 2008.  Was it at the request of the provider?  Was it do to an internal error?  See what the provider says regarding the EIN given to you over the phone and take it from there.

**Fingers Crossed**

Michele
Title: Re: Tax ID numbers
Post by: PMRNC on May 12, 2010, 11:05:11 AM
Hindsight is 20/20, the EIN should have been checked BEFORE claims were submitted, we are not just talking claim issues here, but IRS problems as well. I would contact the clearinghouse/carriers and get the claims back or rejected, YOU don't want those claims paid if the EIN is NOT correct. This is why the carrier should NOT have given the EIN out to begin with, it opens a whole other can of worms, the provider MUST go through their records, correspond with The IRS and get this sorted out, after that I would get some sort of documentation from your client before submitting claims JUST to cover yourself.
Title: Re: Tax ID numbers
Post by: lgentle on May 20, 2010, 01:06:53 PM
I am new at this and I would like to know what an EIN number is?
Thanks
Title: Re: Tax ID numbers
Post by: PMRNC on May 20, 2010, 03:42:04 PM
Employer identification number
Title: Re: Tax ID numbers
Post by: Michele on May 20, 2010, 08:34:27 PM
The EIN number is the number used to report income to the government.
Title: Re: Tax ID numbers
Post by: lgentle on May 21, 2010, 11:05:44 AM
Thank you so much. I know it seem like a crazy ques.
Title: Re: Tax ID numbers
Post by: Ultraserve on May 29, 2010, 12:19:35 AM
You can also look up the Physician's information on the National Provider Identification website by doing a search on his name, this will give you the providers full name, addresses (mailing and practice location) and all his identification numbers from various insurance companies, from NPI, PTNN, API, UPIN, GROUP# etc..; visit the NPI Registry at https://nppes.cms.hhs.gov.
Title: Re: Tax ID numbers
Post by: blhoffman on May 29, 2010, 06:43:09 PM
We use this site also. I have it saved in my favorites. Good advice!
Title: Re: Tax ID numbers
Post by: CPOWELL on June 12, 2010, 10:34:39 PM
I had a similiar action happen - and after exhausted digging etc: the simple question that I didn't ask the claims dept was - who did you send the check to?; Long story short - the carrier had associated our physicans name with another physician with the same name in another area of Maryland and they were sending claims to that physician. because in a transition move at the insurance carrier - the tax ID and physician name had been entered into their data base incorrectly - In the end, it was also a group number issue with the claim - as it was priced elsewhere - you all know that routine - and sent to the 'company' to pay the claim - lesson learned - always ask - to whom and what address was on the check/EOB.
Title: Re: Tax ID numbers
Post by: Michele on June 14, 2010, 12:21:46 PM
We always ask "where was the check mailed" and "who was it made out to" AND "was it cashed."
Title: Re: Tax ID numbers
Post by: CPOWELL on June 15, 2010, 10:27:36 AM
YES.....that is the most important question...and on another note: I had a few checks given to another medical practice in the building by the postman. Those checks were cashed by that practice and honored at their bank - the insurance carriers stated that since the check was cashed it was out of their hands and unless I give them a copy of the check with an appeal letter - they can't do anything - so I went down to the office (the insurance carrier had a copy of the check back and that is how I came to find out where it went) to request that they write a check to us as the money received was not theirs and to make it simple, just give us a check and they would balance out and we would be able to balance and not write off the patient's accounts - to my disbelief - that office was not willing to do that - they said I had to prove it to them - round and round the spinning wheel goes....unbelievable what we go thru in the business office!
Title: Re: Tax ID numbers
Post by: PMRNC on June 15, 2010, 10:29:19 AM
That was wrong, the insurance company is to re-issue and then go after the provider that cashed the checks on their own. I would request a supervisor and then tell them you plan to go to the insurance commissioner or the banking and insurance department in your state.
Title: Re: Tax ID numbers
Post by: Michele on June 16, 2010, 05:12:14 PM
We had a situation where the insurance company told us that we had to wait until the other dr returned the money.  They had mailed it to the wrong provider.  We told them if they didn't reissue the check immediately we would report them to the insurance commissioner.

Michele
Title: Re: Tax ID numbers
Post by: PMRNC on June 17, 2010, 09:41:55 AM
That's right Michelle, they don't have a right of recovery for claims paid in ERROR by them. They will however Try to verbally tell you to wait, tell them to put that in writing and you will then file the report with the state dept of insurance.