Medical Billing Forum

General Category => General Questions => Topic started by: Billing2 on January 14, 2016, 04:52:24 PM

Title: Horiozn Value Option Mental Health Claims
Post by: Billing2 on January 14, 2016, 04:52:24 PM
I'm hoping someone can enlighten me on an issue that I am having. Since the middle of November Horizon /Value Options is paying claims completely wrong over paying. Paying more than we even put on the claim. I have called them 42 times saying you're paying the claims wrong. They say but what should we paid you and I said per the fee schedule. They said but what is that, I stated I should not have to tell you your fee schedule. We are still getting claims paid wrong and I'm just wondering if anybody else is having this issue with them and if so what have you been told >:( >:( >:( >:(

Title: Re: Horiozn Value Option Mental Health Claims
Post by: kristin on January 14, 2016, 08:46:44 PM
Hmmm....either their system is glitching, or maybe they did a fee schedule adjustment, and really raised allowed amounts? I wish I knew what to advise, but I have never seen that happen before.
Title: Re: Horiozn Value Option Mental Health Claims
Post by: PMRNC on January 14, 2016, 09:27:37 PM
Quote
Since the middle of November Horizon /Value Options is paying claims completely wrong over paying. Paying more than we even put on the claim. I have called them 42 times saying you're paying the claims wrong. They say but what should we paid you and I said per the fee schedule. They said but what is that, I stated I should not have to tell you your fee schedule. We are still getting claims paid wrong and I'm just wondering if anybody else is having this issue with them and if so what have you been told

I do a lot of value options.. from what you say above I can't make heads or tails of what your talking about. I think you need to be a bit more specific
Title: Re: Horiozn Value Option Mental Health Claims
Post by: Billing2 on January 15, 2016, 02:34:01 PM
Here is an example of what I'm talking about.  Client's all have a NJX3HZN policy. It's happen only to my LPC not LCSW.

Bill date 12/16/15 a 90837 @ $140.00 they allowed $ 136.55 and Paid $ 136.55. 
Bill date 12/23/15 a 90837 @ $140.00 they allowed $ 60.00  and Paid $ 45.00 
Bill date 12/16/15 a 90837 @ $140.00 they allowed $ 117.00 and Paid $ 107.00

Per the Fee schedule it should be $ 73.00. 

I hope that helps.  Just seen if anyone else is having the same issue. 
Title: Re: Horiozn Value Option Mental Health Claims
Post by: rdmoore2003 on January 15, 2016, 03:01:36 PM
I had a similar issue not to long ago with them.  I had to contact the provider relations dept.  There was a "glitch" in the provider's file that "popped" up and it had linked itself to another provider's fee schedule from a completely different area.   Call your provider relations dept and they should be able to help you.
Title: Re: Horiozn Value Option Mental Health Claims
Post by: Billing2 on January 15, 2016, 05:50:35 PM
Glad to know it's just not me. I've reached out them them. Hopefully I'll hear back soon.

It's all my providers in NJ. I have many different county's.  Let's hope they fix it soon. I just tell my providers the amount of over payment and to keep it off to the side for the A/R that will take place.