Author Topic: EOB procedure dates  (Read 1822 times)

duner

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EOB procedure dates
« on: August 27, 2014, 04:01:42 PM »
I submitted a claim to Cigna Healthcare on a paper CMS-1500.  Line 1 is a date range of 5/1/14-5/6/14, per diem HCPC, 6 units.  Line 2 is a date range of 5/7/14-5/12/14, per diem HCPC, 6 units.  They paid the claim and I have no issue with what they paid, however, there is further reimbursement possible at a secondary payer, and how they listed the service dates is insufficient to send to the secondary.  The problem is they only list a single "procedure date" for each line on the eob, so line 1 looks like only one day, "5/1/14," and line 2 only looks like one day, "5/7/14."  Number of units isn't listed anywhere either, so it looks like they paid a very large amount for one day of service. >:(  They will not do anything to correct or clarify the EOB, stating their internal system shows the full date range and that is just how their EOB's print.  I have a call in to Cigna Provider Relations and am prepared to file a complaint with the TN insurance commission, but want to know if a regulation exists I can reference mandating an EOB reflect the exact dates given on a 1500?  If CMS allows for a from and a to, one would think EOB's must reflect that as well.

PMRNC

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Re: EOB procedure dates
« Reply #1 on: August 27, 2014, 04:20:43 PM »
You don't mention if you TRIED to send it to the secondary.. I'm thinking you will need something from the secondary in order to appeal the way the primary paid.
Linda Walker
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duner

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Re: EOB procedure dates
« Reply #2 on: August 27, 2014, 06:39:17 PM »
I am very familiar with the secondary payer, who I already know will not consider this EOB any more than one day per line.  I know if I go the appeal route I will need to send the secondary claim to get their response.  I'm actually more interested in knowing the regs on this issue, though, if there are any. 

PMRNC

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Re: EOB procedure dates
« Reply #3 on: August 27, 2014, 06:48:15 PM »
Here's what I would do.. I would submit an itemized billing statement exactly as you billed it WITH the secondary EOB/consideration.. take it from there. You really don't have an appeal at this point if CIGNA is saying they considered it accordingly.. but if you submit an actual itemized billing statement WITH the EOB and get the secondary consideration you can see what your left with. Hope that makes sense. You really can't assume anything until both carriers have paid and then you have to see where the appeal goes.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

duner

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Re: EOB procedure dates
« Reply #4 on: August 28, 2014, 12:42:29 PM »
Thanks for your advice.

Merry

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Re: EOB procedure dates
« Reply #5 on: August 28, 2014, 07:11:10 PM »
Were these dates of service for professional services.. I.e. visit  in a hospital.  If so.... I never bill from-thru for this reason. I list every date individually.. Even if it for a month.    If it for facility billing.. I bow out.