Author Topic: Are any United Healthcare providers getting paid more than capped daily rate?  (Read 1028 times)

2012billingrep

  • Newbie
  • *
  • Posts: 23
Hi,

I am billing for a chiropractor in FL who is contracted with United Healthcare on a per diem rate. Some claims we have received have paid per line item which totals more than the per diem rate. When we called to find out if this was correct, we were told different things. Pretty much all of them say the claims are processed correctly. One rep said that State mandate only applies if it is a fully insured plan but does not apply when it is a self insured plan/self-funded plan.

The contracting department have said that all FL providers for chiropractic are under a per diem rate and not per line item. According to them, the doctor was incorrectly listed to be paid per line item and has been corrected to a per diem rate, however we are still getting paid per line item for some patients. We always call the claims dept to check on this and they always say it is processed correctly. Today when we called, is the first time we've heard of there being a difference in how the claims are paid depending on whether it is a fully insured plan or self funded and apparently this bypasses the per diem contracted rate.

Has anyone noticed this with UHC claims? Where some pay more than others when on a capped daily rate?



« Last Edit: July 21, 2014, 09:39:40 AM by 2012billingrep »

PMRNC

  • Hero Member
  • *****
  • Posts: 4252
    • One Stop Resources & Networking for Medical Billers
One of the big things you don't mention is a "contract" .. by saying you are contracted on a "per diem" rate really doesn't answer the main question. Do you have a contract with UHC? What does that contract say? Is there an "All products clause" in that contract?

Quote
The contracting department have said that all FL providers for chiropractic are under a per diem rate and not per line item

This doesn't say enough because, again, it depends on YOUR contract with UHC.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com