Author Topic: The "Where to send claims" runaround!  (Read 6132 times)

DMK

  • Hero Member
  • *****
  • Posts: 680
The "Where to send claims" runaround!
« 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

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4705
    • Solutions Medical Billing
Re: The "Where to send claims" runaround!
« Reply #1 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
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: The "Where to send claims" runaround!
« Reply #2 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).  ;)

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: The "Where to send claims" runaround!
« Reply #3 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 :(
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

tlewis

  • Newbie
  • *
  • Posts: 40
Re: The "Where to send claims" runaround!
« Reply #4 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

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4705
    • Solutions Medical Billing
Re: The "Where to send claims" runaround!
« Reply #5 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!
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: The "Where to send claims" runaround!
« Reply #6 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!

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: The "Where to send claims" runaround!
« Reply #7 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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: The "Where to send claims" runaround!
« Reply #8 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! :-\

Alice Scott

  • Global Moderator
  • Full Member
  • *****
  • Posts: 209
    • Solutions Medical Billing
Re: The "Where to send claims" runaround!
« Reply #9 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 lately that I couldn't answer that post without offering a marketing tip.
Alice
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

QueenAlicia

  • Sr. Member
  • ****
  • Posts: 347
Re: The "Where to send claims" runaround!
« Reply #10 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.

Pay_My_Claims

  • Guest
Re: The "Where to send claims" runaround!
« Reply #11 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??

medauthor

  • Full Member
  • ***
  • Posts: 130
    • Professional Medical Billers Association
Re: The "Where to send claims" runaround!
« Reply #12 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 :(
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

Pay_My_Claims

  • Guest
Re: The "Where to send claims" runaround!
« Reply #13 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.

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: The "Where to send claims" runaround!
« Reply #14 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!!!!!