Author Topic: Diffaculty getting reimbursed...  (Read 4284 times)

rachel

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Diffaculty getting reimbursed...
« on: July 21, 2009, 09:32:10 AM »
Hi Everyone,

I am hoping someone will be able to give me some advice on aged claims that we are having a very diffacult time getting reimbursed.  I took on a provider who had not billed for the last year and we are now attempting to collect (they are not out of date yet).  I have called every week since first filing about 2 months ago and for the first 5-6 weeks was told they needed the dr's address and phone, which i repeatedly provided to them and they said they would resubmit but this never got us anywhere - I believe it was a stall tactic.  So when I asked to speak to a supervisor, I was told they had requested the claims be faxed over so they would have hard copies for review, which I was never informed but that is neither here nor there. So we faxed over all the claims and now they are in review.

Does anyone have any advice on how to get this situation resolved?  Is there a dept/someone (other than claims) to contact that may move this forward, it is really fustrating and I almost feel as if they are stalling in hopes we will give up.

Thank you,

Rachel

PMRNC

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Re: Diffaculty getting reimbursed...
« Reply #1 on: July 21, 2009, 10:09:41 AM »
What carrier?
Is there a problem with the TAX ID/Providers Address?. NPI?  Did the claim forms have this information on them? Is the carrier saying they didn't get the claims?
Did you file them on paper? Electronic? Do you have proof of them receiving claims (report).

To really say what to do depends on those questions.
Linda Walker
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rachel

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Re: Diffaculty getting reimbursed...
« Reply #2 on: July 21, 2009, 10:18:45 AM »
It is United Behavioral Health...all info was on claim, which originally was filed Electronically and I even contacted my clearinghouse to double check and they even called UBH to see what the issue was and was told the same thing, they needed the providers address and phone number, they definately had the info and even if it was not on the original claims (which it was) it was provided to them no less than 5 times thereafter when I called to check on the claims status....they confirmed receipt of the claims verbally and I have a report from the clearinghouse as well.

Any suggestion????

Pay_My_Claims

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Re: Diffaculty getting reimbursed...
« Reply #3 on: July 21, 2009, 10:40:22 AM »
I hate to laugh, but before you answered, I KNEW it was UHC. They ALWAYS bulldog claims asking for that same information!!..

Others may have more information, but for me it has been loading down the system with calls!!!

PMRNC

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Re: Diffaculty getting reimbursed...
« Reply #4 on: July 21, 2009, 11:12:40 AM »
Me too.. I knew it was going to be UHC.. LOL
What I usually do is insist on speaking to a supervisor with the reports in my hand. I tell them I am looking at the same claim they have and that you want them processed ASAP. If they still stall I always ask them to backup their request in Writing and tell them you will forward it on to the State Dept of Insurance in your state.

OR

Go ahead, gather all the claims, proof of submission report, confirmation of their receipt by UHC and a letter and send it right on to the State Dept of Insurance for your state.

It also wouldn't help to quote your state prompt pay/consideration law.
Linda Walker
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www.billerswebsite.com

rachel

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Re: Diffaculty getting reimbursed...
« Reply #5 on: July 21, 2009, 11:33:28 AM »
wow...at least I know its not me...we have been doing the call thing daily as of last week just to see if it would get us anywhere - to no avail - i think we may try the state law route and see if that gets anywhere....

Thanks - as always you guys have great info!

Michele

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Re: Diffaculty getting reimbursed...
« Reply #6 on: July 21, 2009, 08:59:15 PM »
Not only UHC, but UBH UHC!
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PMRNC

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Re: Diffaculty getting reimbursed...
« Reply #7 on: July 22, 2009, 07:26:53 AM »
You know it's funny Michele, but I never have a problem with UBH, I'd rather deal with them than UHC any day!
Linda Walker
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Michele

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Re: Diffaculty getting reimbursed...
« Reply #8 on: July 22, 2009, 07:45:24 AM »
I've just had one psychologist in particular and what a run around UBH gives him!  It is terrible.  So I guess I'm really basing it on just the one provider, but sometimes the experience is sooooooo bad!  You can't help it! >:(

Michele
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Pay_My_Claims

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Re: Diffaculty getting reimbursed...
« Reply #9 on: July 22, 2009, 08:08:29 AM »
UBH. UHC, all under United Health Group. Same company same issues.

PMRNC

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Re: Diffaculty getting reimbursed...
« Reply #10 on: July 22, 2009, 11:56:38 AM »
Yes they are all subsidiaries and TPA's of United Healthcare, however no I wouldn't agree same issues at all.
I do a lot of UBH (United Behavioral Health) and they are way different to deal with than UHC, claims are even processed in different places.
Linda Walker
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Pay_My_Claims

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Re: Diffaculty getting reimbursed...
« Reply #11 on: July 22, 2009, 12:21:53 PM »
Yes they are all subsidiaries and TPA's of United Healthcare, however no I wouldn't agree same issues at all.
I do a lot of UBH (United Behavioral Health) and they are way different to deal with than UHC, claims are even processed in different places.

OK, UBH is who she is having issues with.

PMRNC

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Re: Diffaculty getting reimbursed...
« Reply #12 on: July 22, 2009, 01:33:55 PM »
Quote
OK, UBH is who she is having issues with.

No, LOL  Michele said she had issues with UBH.. I said I didn't LOL
Linda Walker
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rachel

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Re: Diffaculty getting reimbursed...
« Reply #13 on: July 30, 2009, 09:00:57 AM »
Hi I wanted to give an update on this situation, it seems as if there was an "internal glitch" w/ their system.  In box 33 the software apparently was reading the dr's designation as her last name and thus could not find her in the system.  This information took 2 1/2 months to figure out on their end.  If anyone has claims w/ UBH beware of this internal glitch!!!!

PMRNC

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Re: Diffaculty getting reimbursed...
« Reply #14 on: July 30, 2009, 09:45:03 AM »
Rachel, is that limited to your clearinghouse/Software?? I have not had any issues and I do a lot of UBH
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com