Author Topic: Box 33 of HCFA  (Read 2908 times)

missy04

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Box 33 of HCFA
« on: October 24, 2012, 08:53:29 PM »
I work for for a medical billing company. We do only physician billing. One client is, a group pf trauma doctors, they have contracts with only three insurance companies. However when we do send the bill as a non par provider instead of denying the claim as out of network, one company in particular ignores the billing info in box 33 and looks at the rendering provider. If that doctor has a contract they process the bill with that doctors info even though the group as a whole does not have a contract. Can they do that? Whats the point in putting anything in box 33 of the HCFA if they don't process the claim accordingly? Secondly, for another group,I had an MCO, due to a billing error and no npi for the group in box 33,pay a claim, supposedly, to the rendering provider based on info they pulled from his npi. shouldn't the claim be denied so the biller can fix the error? Or can the insurance company just chose then to pay according to the rendering doctors info? The provider never got the money someone cashed the check and we were told we had to request the money from the facility they paid in error. It wasnt even paid to the address in box 33.

PMRNC

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Re: Box 33 of HCFA
« Reply #1 on: October 25, 2012, 11:29:43 AM »
You want to first access the actual contracts for those carriers.  It's very possible that the contract will be a group contract at par rates.  Only the contract is going to tell you this information.   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

missy04

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Re: Box 33 of HCFA
« Reply #2 on: October 25, 2012, 12:24:15 PM »
But what I'm saying is we dont have a group contract with them. And because we dont instead of denying claim as out of network the look at the rendering individual provider and if he individually is contract they ignore the group we are billing for info in box 33.

PMRNC

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Re: Box 33 of HCFA
« Reply #3 on: October 25, 2012, 04:06:03 PM »
If the rendering provider IS par he has a contract that contract will supersede things..  If a provider has a contract and renders services, it only stands to reason he would be subject to terms of his contract.  Likewise they would consider out of network if the rendering provider was not contracted.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com