Hello,
This question relates to how insurance companies deal with Dr office's Tax IDs.
A Dr's office has a Tax ID they use to submit claims to an insurance company (i.e:Aetna). Lets say the Tax Id is (123456789). This Drs office has always used this tax id to submit their patients claims and the insurance company always viewed them as (in-network) for all these years. For some weird reason insurance is alledging that the drs office is sending claims under an (out of network) tax ID (12345789). But the doctors office says for all these years they have been using that same TAX ID (123456789) which is always( in network ) and insurance has always processed these claims as (in network.)
A couple months ago patients started getting billed for seeing this Dr as an out of network Dr. The insurance is alledging that this Tax id (which the dr has used for many many years - is now out of network) . Insurance claims they have another tax id on file, lets call it tax id# (34343434) which is an in network tax Id which is the one the dr SHOULD be using. The problem is the Drs office has no affiliation with this tax id and doesnt understand where it came from.
So the question is:
1.) how come all of a sudden now the insurance is saying their Tax id (123456789) is out of network, while a few months ago this tax id was used to process claims and was viewed as In network. What went wrong?
Insurance was ALWAYS processing claims under the tax is (123456789) as in network. How is it possible that now that tax Id is deemed invalid when the whole time the insurance WAS processing claims as in network and stopped doing this a few months ago and now deems the tax id as out of network?
Thanks