Author Topic: Release of info to 3rd party billing services  (Read 1833 times)

ste

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Release of info to 3rd party billing services
« on: September 18, 2013, 01:47:04 AM »
The local state-chartered workers' comp insurance company has a policy to not release any patient information to 3rd party billing service companies. They make it very difficult for me to follow up on claims which I have submitted.

I always start out the conversation with, "I am calling from ......", but there have been times when the adjuster will say, "so and so from your office just called me about this claim and ....." At this point I just tell them that I am the contracted biller for the group of medical providers and they refuse to speak with me any further.

What is the best way to remedy this so I can follow up on claims? 

Sriram_Sub

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Re: Release of info to 3rd party billing services
« Reply #1 on: September 18, 2013, 03:29:57 AM »
I think it would be good to send an authentication letter from your provider under the provider's letter head to any workers comp insurance you submit claims to. May not necessarily be needed to send it for every claim submitted but at least once to let them know that  you are approved to deal with the patient's claims on behalf of the provider. JMO.
Sriram

ste

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Re: Release of info to 3rd party billing services
« Reply #2 on: September 18, 2013, 12:52:25 PM »
I've offered to supply the insurance company with such a letter but the adjuster told me it would do no good.

PMRNC

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Re: Release of info to 3rd party billing services
« Reply #3 on: September 18, 2013, 03:38:32 PM »
I do NOT receive the PHI in cases like this direct. I call and state what office I'm calling on behalf of and the information goes to the provider, what I need for billing he/she gives me. That is pretty simple, why fight it when you can just get the information from the provider directly. The carrier is correct in NOT sending you the information. ALL information I request from any carrier always goes to my client/provider. I DO not want it coming to me, let the provider send you what you need.

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ste

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Re: Release of info to 3rd party billing services
« Reply #4 on: September 19, 2013, 05:24:56 PM »
Somewhere there is a misunderstanding here.
I am taking about following up on a claim. For example, if I have the EOR in front of me and see that the procedure on line one did not pay because the adjuster couldn't find the information in the chart notes, then I call the insurance and point out to them where that information actually is on the chart notes. The adjuster sends the claim back for reprocessing, the procedure gets paid, and the provider is happy.
I realize Linda that you have the chart notes sent directly from the office to the insurance, so this might not be the best example.
My point is claims need to be followed up on. If I can't get past the the gate to follow up on claims, then way too many will go unpaid. 














 

Sriram_Sub

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Re: Release of info to 3rd party billing services
« Reply #5 on: September 20, 2013, 02:50:39 AM »
I always start out the conversation with, "I am calling from ......", but there have been times when the adjuster will say, "so and so from your office just called me about this claim and ....." At this point I just tell them that I am the contracted biller for the group of medical providers and they refuse to speak with me any further.

I just read your post again. The best way to handle this is that you make sure no one has called before you did so that you may not get that response from the Adjuster "So and So from your office....". Every time someone else (from the provider's office) follows up on the claim, they will have to make a note on the claim so it will be available for you to review before you decide to make a call. Also, as said by Linda, you could say that "I am CALLING ON BEHALF OF <the provider's name> (not "CALLING FROM <Provider's name> which might sound to be fake), instead of mentioning that you are the contracted biller for the provider.
Sriram

PMRNC

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Re: Release of info to 3rd party billing services
« Reply #6 on: September 23, 2013, 04:24:59 PM »
Quote
I realize Linda that you have the chart notes sent directly from the office to the insurance, so this might not be the best example.
My point is claims need to be followed up on. If I can't get past the the gate to follow up on claims, then way too many will go unpaid


I was going by your very first sentence:

Quote
The local state-chartered workers' comp insurance company has a policy to not release any patient information to 3rd party billing service companies. They make it very difficult for me to follow up on claims which I have submitted.

The policy of the carrier is NOT incorrect. For situations like that you have to just ask them what their procedure is and follow along. They are following their procedures. There are a lot of carriers that will not release info to 3rd party billing companies, they don't have to, your contract with your provider is NOT conclusive of any policy they have in place. That's why I say it's best to state your calling for so and so's office. If you already told them you were a 3rd party billing company and they implemented that policy , most likely they flagged this in their system. Call them and find out their exact procedure. You can also ask them if they will take a fax authorization from the provider and even add this to the file in their system. Worth a shot.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com