Medical Billing Forum

Payments => Insurance Payments => Topic started by: DMK on December 08, 2010, 06:50:48 PM

Title: The "Where to send claims" runaround!
Post by: DMK on December 08, 2010, 06:50:48 PM
Is anyone else having trouble with CIGNA?  I've been verifying benefits, electronic payor ID, and claims mailing address on their website.  When I check on the claim later, they say "incorrectly submitted, claim should be sent to ASHN at P.O. Box  etc;

These are chiropractic claims, and I'm very familiar with ASHN and their procedures, but shouldn't it be noted in the chiropractic benefits section that claims are sent to a different location?

I'm beginning to think they're just slowing down payment on purpose, and they were already the slow boat to China for payments!

I would really appreciate any feedback.  If I'm looking in the wrong place for where to send claims I'd love to know where the right place is!!!

Thanks all!

Dina
Title: Re: The "Where to send claims" runaround!
Post by: Michele on December 09, 2010, 06:46:17 AM
When you verify benefits are you specifically asking "what is the address or payor ID for CHIROPRACTIC claims"?  Sometimes you need to even come right out and say "Do these go to ASHN?"

Frustrating!

We don't do a lot of CIGNA billing, but we haven't noticed any huge issues.

Michele
Title: Re: The "Where to send claims" runaround!
Post by: DMK on December 09, 2010, 11:18:13 AM
When I call to verify information, more and more often, there is an automated response only, and they keep referring to their website.  Since I have to have an account on their website with all the provider info, the benefits that come up are for our specialty, you would think that they would show that chiro claims go to ASHN (but that would be too easy).  ;)
Title: Re: The "Where to send claims" runaround!
Post by: PMRNC on December 09, 2010, 07:35:33 PM
With all the TPA's out there I have to come right out and ask : WHICH ADDRESS DO WE SEND CLAIMS!  It is frustrating but vital as it's the first step in the insurance reimbursement cycle. I do a lot of Cigna out here but I can't really say we have any problems with claims addresses for the TPA's but I always ask, I do mostly MH billing and deal with a lot of TPA's. My biggest pain in butt is out of state BCBS :(
Title: Re: The "Where to send claims" runaround!
Post by: tlewis on January 24, 2011, 05:41:09 PM
helpful hint. If you are trying to reach an actually person at any insurance company and only get the machine run around, try hitting 0 over and over again. Or my favorite evertime they ask for info say supercalifragilisticexpialidocious. The computer wil become confused and say. I'm sorry I cannot understand you and transfer you to a person..
added bonus. people walking by your office will think you finally had on claim to many to deal with. ;D  ;D  ;D  ;D
Title: Re: The "Where to send claims" runaround!
Post by: Michele on January 25, 2011, 08:46:06 AM
Interesting!  I usually put in id# 00000000000000000 which they ask for repeatedly because they can't locate that id #.  But eventually I usually get transferred to a live human!  I may try supercalifragilisticexpialidocious!
Title: Re: The "Where to send claims" runaround!
Post by: DMK on January 25, 2011, 10:36:27 AM
Does anyone else find it sad that we have to come up with ways to "fool" the computer to get to a live person? 

I try to be clear and concise with the computer so that when I finally do get a person they will have all the correct information right in front of them.  Then you get the operator from overseas that you can't understand, who can not seem to pull up the information you so diligently entered, who can't answer your question anyway!  How many millions of dollars does this inefficiency cost the insurance company?  I'll bet it saves them money by billers getting frustrated, hanging up, and not pursuing the claim at all!    ARRRGGGHHHH !!!!!!!

I'd get fired if I did my job like that!
Title: Re: The "Where to send claims" runaround!
Post by: PMRNC on January 26, 2011, 07:00:40 PM
Quote
helpful hint. If you are trying to reach an actually person at any insurance company and only get the machine run around, try hitting 0 over and over again. Or my favorite evertime they ask for info say supercalifragilisticexpialidocious. The computer wil become confused and say. I'm sorry I cannot understand you and transfer you to a person..
added bonus. people walking by your office will think you finally had on claim to many to deal with

Ahhh...but on the flip side of this, i worked as a claims examiner for 3 MM carriers and with 2 of them, claims examiners did NOT have to do customer service.. so many times hitting that zero bounced you around and well, let's just say when you are working on production/quality.. it's annoying and many times you won't find it's beneficial to piss off the claims examiners. LOL  I usually call provider relations and ask for a representative.. works everytime.
Title: Re: The "Where to send claims" runaround!
Post by: DMK on January 28, 2011, 12:49:59 PM
Here's the latest episode in my saga.

I had an Cigna claim, administered by APWU.  I looked up the claim on the CIGNA site, a note popped up that this patient's claims were administered by APWU and to call them with questions at 800 xxxxxxxx. 

I called APWU, got a really nice lady, she says "We don't have any claims on record for this patient, from this provider".  I've sent the claim electronically 3 times (I have the e-claim acceptance receipt from CIGNA) and 1 time on paper.  She says "Well let's get CIGNA on the line and we'll find the claims." 

She sets up a 3 way conference call with me and CIGNA.  The claim rep at CIGNA says "Yes, here are the claims, the provider has to send the claims to ASHN for pricing.  They should have known that."  So I say "There's been NO notification to APWU, NO notification to us, there is NO note on the site that they ask us to use instead of calling, how am I supposed to know there's anything amiss with the claim?"  She says, "I can't answer that."  The APWU rep says "Why weren't we informed that you were requiring the claims to go to another party other than CIGNA?"  The CIGNA rep can't answer that either.  So an investigation is underway. 

Wow.   How hard would it be to put on the CIGNA site (that they would really appreciate the providers using) where to send claims?  I am logging in with a tax ID so they know who I am, and what our contract is.  I guess it's just another crack in the system!  Hopefully other providers will benefit in the future by having the CORRECT information on the site they would like us to use to reduce call volume.

So, I'm billing a 5th time to the 4th party for pricing.  I may get paid before a year is up! :-\
Title: Re: The "Where to send claims" runaround!
Post by: Alice Scott on January 29, 2011, 05:34:25 AM
It's good for beginners to know that this type of thing happens.  When it happens to you for the first time you have no idea how far you will have to go to get this claim paid.  Many offices let a thing like this fall thru the cracks and never get paid.  Some think that it's not worth the bother.  I congratulate DMK on taking it this far!!
Many of our readers are beginning medical billing services and you need to know that this is how you convince dotors to allow you do their billing - by going the extra mile - by collecting everything.  Let them know that you don't let these things slide by.  Even if it does take a year to get the claim paid, it does need to get paid and you can differentiate your service by going to these lengths.

Sorry...  I've been doing so much writing for our new marketing program (http://our new marketing program) lately that I couldn't answer that post without offering a marketing tip.
Alice
Title: Re: The "Where to send claims" runaround!
Post by: QueenAlicia on February 07, 2011, 05:16:57 PM
Here's the latest episode in my saga.

I had an Cigna claim, administered by APWU.  I looked up the claim on the CIGNA site, a note popped up that this patient's claims were administered by APWU and to call them with questions at 800 xxxxxxxx. 

I called APWU, got a really nice lady, she says "We don't have any claims on record for this patient, from this provider".  I've sent the claim electronically 3 times (I have the e-claim acceptance receipt from CIGNA) and 1 time on paper.  She says "Well let's get CIGNA on the line and we'll find the claims." 

She sets up a 3 way conference call with me and CIGNA.  The claim rep at CIGNA says "Yes, here are the claims, the provider has to send the claims to ASHN for pricing.  They should have known that."  So I say "There's been NO notification to APWU, NO notification to us, there is NO note on the site that they ask us to use instead of calling, how am I supposed to know there's anything amiss with the claim?"  She says, "I can't answer that."  The APWU rep says "Why weren't we informed that you were requiring the claims to go to another party other than CIGNA?"  The CIGNA rep can't answer that either.  So an investigation is underway. 

Wow.   How hard would it be to put on the CIGNA site (that they would really appreciate the providers using) where to send claims?  I am logging in with a tax ID so they know who I am, and what our contract is.  I guess it's just another crack in the system!  Hopefully other providers will benefit in the future by having the CORRECT information on the site they would like us to use to reduce call volume.

So, I'm billing a 5th time to the 4th party for pricing.  I may get paid before a year is up! :-\

Thanks for sharing this. I hope they pay you before the end of the year.
Title: Re: The "Where to send claims" runaround!
Post by: Pay_My_Claims on February 07, 2011, 06:47:36 PM
Here's the latest episode in my saga.

I had an Cigna claim, administered by APWU.  I looked up the claim on the CIGNA site, a note popped up that this patient's claims were administered by APWU and to call them with questions at 800 xxxxxxxx. 

I called APWU, got a really nice lady, she says "We don't have any claims on record for this patient, from this provider".  I've sent the claim electronically 3 times (I have the e-claim acceptance receipt from CIGNA) and 1 time on paper.  She says "Well let's get CIGNA on the line and we'll find the claims." 

She sets up a 3 way conference call with me and CIGNA.  The claim rep at CIGNA says "Yes, here are the claims, the provider has to send the claims to ASHN for pricing.  They should have known that."  So I say "There's been NO notification to APWU, NO notification to us, there is NO note on the site that they ask us to use instead of calling, how am I supposed to know there's anything amiss with the claim?"  She says, "I can't answer that."  The APWU rep says "Why weren't we informed that you were requiring the claims to go to another party other than CIGNA?"  The CIGNA rep can't answer that either.  So an investigation is underway. 

Wow.   How hard would it be to put on the CIGNA site (that they would really appreciate the providers using) where to send claims?  I am logging in with a tax ID so they know who I am, and what our contract is.  I guess it's just another crack in the system!  Hopefully other providers will benefit in the future by having the CORRECT information on the site they would like us to use to reduce call volume.

So, I'm billing a 5th time to the 4th party for pricing.  I may get paid before a year is up! :-\

When calling for benefits, do you ask for the claims address??
Title: Re: The "Where to send claims" runaround!
Post by: medauthor on February 07, 2011, 07:48:08 PM
Quote
When calling for benefits, do you ask for the claims address??

Even with a claims address, they may still forward it to someone else for pricing :(
Title: Re: The "Where to send claims" runaround!
Post by: Pay_My_Claims on February 07, 2011, 08:04:03 PM
agreed, because Medcost itself is a repricing agency.  When you call for benefits, they ask are you contracted. If you are you send it to Medcost for repricing, if you are not, it will go to the insurance carrier. from what I get off the post, she just looked at the info on the website.
Title: Re: The "Where to send claims" runaround!
Post by: DMK on February 08, 2011, 10:59:02 AM
I do verify where to send claims, we are contracted, I sent the claim where they said to send it, and I STILL got the run around.  APWU was very understanding, and very interested to know what was happening to their claims (CIGNA was the claims processor, APWU was the administrator). 

I did more research with ACN/ASHP (the pricing company) and they didn't list CIGNA as one of the companies who were contracted with them.  So frustrating.  And (I'm going to whine again) I will send the claims wherever they tell me...just quit changing the place!!!!!
Title: Re: The "Where to send claims" runaround!
Post by: Pay_My_Claims on February 08, 2011, 02:30:12 PM
@ DMK....i feel your agony (hug)
Title: Re: The "Where to send claims" runaround!
Post by: PMRNC on February 08, 2011, 04:17:15 PM
Quote
I do verify where to send claims, we are contracted, I sent the claim where they said to send it, and I STILL got the run around.  APWU was very understanding, and very interested to know what was happening to their claims (CIGNA was the claims processor, APWU was the administrator).

I did more research with ACN/ASHP (the pricing company) and they didn't list CIGNA as one of the companies who were contracted with them.  So frustrating.  And (I'm going to whine again) I will send the claims wherever they tell me...just quit changing the place!!!!!

What's even MORE aggravating is when you go through all of that only to find out the patient had EAP visits to use first and you just sent it to major medical who sent it or told you to send it to the mental health TPA... and you have just violated privacy.. all in the name of trying to do the right thing in the first place!  I always blame the verification/authorization line because when they know it's mental health they are supposed to first see if the patient has EAP!  I've had this happen a few times!
Title: Re: The "Where to send claims" runaround!
Post by: DMK on April 05, 2011, 01:47:05 PM
When I call the insurance company to inquire about claims that seem to have "disappeared", is there a better place to go to rather than just "claims"?  Would provider relations be the better option?

This CIGNA and United HealthCare fiasco is about to break me!  We keep getting more of these patients, and I can't get good information from the insurance company.

Any suggestions?
Title: Re: The "Where to send claims" runaround!
Post by: rdmoore2003 on April 05, 2011, 04:35:13 PM
This CIGNA and United HealthCare fiasco is about to break me!  We keep getting more of these patients, and I can't get good information from the insurance company.

Any suggestions?
[/quote]

If you have contacted customer service reps and claim reps, you may want to speak with your provider relations rep.  This is part of why they are there, to help.  Now with that said, I have found these reps to be sometimes alot more difficult than the actual customer service reps.  I suggess to continue to document everything and everyone you have spoken with and keep "climbing the latter".   Rep, to supervisor, to their supervisor, etc.   

Now, last week I called Medicare with a similar issue.   I was told they no longer have provider reps and they no longer travel to a providers office.  You must give them the patient information and they forward that information to a rep that will call you within 14 business days.   DO NOT LET THIS BREAK YOU!!! 

Title: Re: The "Where to send claims" runaround!
Post by: PMRNC on April 05, 2011, 04:39:35 PM
I have a policy I implemented in my P&P. If I have billed a carrier twice for any claim and they claim NOT to have received it, I call the carrier, request a supervisor and request the name of someone I can speak to in regards to getting that claim to that person. I verify their name, and it goes right on the envelope. No sense wasting more claim submission fees! Oh and if I can fax it I do so again, to the attention of the person I am directed to fax it to.  I try to include a copy of the submission report when possible as well.

I do a lot of Cigna and UHC but usually if I run into this scenario it's just a matter of it being sent to wrong claims office as they have so many of them. Sometimes the verifications don't get to me to find that out right away. occasional.. with any carrier (no rhyme or reason) I will get the old "We didn't get it"  routine.
Title: Re: The "Where to send claims" runaround!
Post by: DMK on April 06, 2011, 10:51:44 AM
Thanks for the support!  My claims are getting to the pricing companies, and the ins. co. is responding to them, but when I look up the claim on the ins. co. site, they don't have the claim.   Ugh.....