Medical Billing Forum

General Category => General Questions => Topic started by: Charles on January 28, 2009, 12:55:37 PM

Title: participating providers
Post by: Charles on January 28, 2009, 12:55:37 PM
Hello,

We run a diagnosis lab and currently have a problem with payment from private insurance companies.
I am wondering if there is a blanket approach to sign-up with private insurance companies to register as a participating provider.  We are currently not getting paid for some claims we submit saying that we are out of network.
Title: Re: participating providers
Post by: Pay_My_Claims on January 28, 2009, 01:32:01 PM
I don't understand what you mean by blanket approach??
I can tell you that providers will contract with specialty providers (DME, Labs etc) and close out to other providers. We are a DME vendor, and the major payers, BCBSNC, Cigna, UHC, have contracted DME providers and WILL NOT ACCEPT any more. They are closed and this limits clients from going to where they want to. We get told all the time, we are not in net work,and I always reply YOU ARE NOT ACCEPTING PROVIDERS!! So we have to collect from your clients and we charge them the full cost. Seems like you will need a good collections team to get the money from the clients.
Title: Re: participating providers
Post by: Charles on January 28, 2009, 01:40:50 PM
Thanks
Title: Re: participating providers
Post by: Michele on January 28, 2009, 07:55:05 PM
There is no blanket approach.  You have to contact each insurance carrier individually and ask what you need to do to become in network. 

Michele
Title: Re: participating providers
Post by: Pay_My_Claims on January 28, 2009, 09:24:14 PM
You are welcome...and yes what Michelle said is true. If you meant blanket approach as a 1 stop shop to be in network with multiple providers...nope each 1 has to be done separately.