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ques re:3rd party repricer Multiplan and Data ISight tactic

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We are out-of-network PT provider in Manhattan

If Data Isight has a failed negotiation with the provider (provider refused to accept the repriced/discounted claim), Cigna will reprocess claim based on their member's plan benefit. This takes time but at least we get paid properly.

Aetna - only started with Data Isight this year. Also, Aetna created a National Advantage program (NAP) seen in almost all Aetna ID card. NAP triggers OoNet claims to be sent to Data Isight for repricing. I managed to disconnect our Tax ID to that program and our claims were reprocessed accordingly but that didn't last long. As of May, our claims are being sent to DI again and according to some Aetna claims supervisors, I was given the wrong information.

My office is looking for legal advice on how to dispute DI discount at this time. We can all help each other!

Sorry but I can't help with legal advice.  I know it's frustrating though.  I hate these middle men.

From my experience, you can negotiate reimbursement for OON PT claims with DataIsight.  For example: Aetna/Cigna. Billed amount $1,350/$1100 for I/E and $880 for F/U- they automatically pay around $130/$150 per visit. When you call DataIsight you can open a case for negotiation and request 40% off of the billed amount. We in NYC usually get around $500-$380 per visit. Not sure what the OON reimbursement is in other states. Hope this info helps.

Please -any help with fighting this Aetna /Data isight is needed.  Called a lawyer versed in these matters-she said its possible Aetna would retaliate against my practice.  This must be fought by an association or legally thru govt channels.   I don't understand why the New york Chiropractic Association or Counsel has not brought action yet.....

If anyone has any any info please advise

I'm sorry but we haven't had any dealings with them.  I'm not sure what to recommend.


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