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Diffaculty getting reimbursed...

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rachel:
Hi Everyone,

I am hoping someone will be able to give me some advice on aged claims that we are having a very diffacult time getting reimbursed.  I took on a provider who had not billed for the last year and we are now attempting to collect (they are not out of date yet).  I have called every week since first filing about 2 months ago and for the first 5-6 weeks was told they needed the dr's address and phone, which i repeatedly provided to them and they said they would resubmit but this never got us anywhere - I believe it was a stall tactic.  So when I asked to speak to a supervisor, I was told they had requested the claims be faxed over so they would have hard copies for review, which I was never informed but that is neither here nor there. So we faxed over all the claims and now they are in review.

Does anyone have any advice on how to get this situation resolved?  Is there a dept/someone (other than claims) to contact that may move this forward, it is really fustrating and I almost feel as if they are stalling in hopes we will give up.

Thank you,

Rachel

PMRNC:
What carrier?
Is there a problem with the TAX ID/Providers Address?. NPI?  Did the claim forms have this information on them? Is the carrier saying they didn't get the claims?
Did you file them on paper? Electronic? Do you have proof of them receiving claims (report).

To really say what to do depends on those questions.

rachel:
It is United Behavioral Health...all info was on claim, which originally was filed Electronically and I even contacted my clearinghouse to double check and they even called UBH to see what the issue was and was told the same thing, they needed the providers address and phone number, they definately had the info and even if it was not on the original claims (which it was) it was provided to them no less than 5 times thereafter when I called to check on the claims status....they confirmed receipt of the claims verbally and I have a report from the clearinghouse as well.

Any suggestion????

Pay_My_Claims:
I hate to laugh, but before you answered, I KNEW it was UHC. They ALWAYS bulldog claims asking for that same information!!..

Others may have more information, but for me it has been loading down the system with calls!!!

PMRNC:
Me too.. I knew it was going to be UHC.. LOL
What I usually do is insist on speaking to a supervisor with the reports in my hand. I tell them I am looking at the same claim they have and that you want them processed ASAP. If they still stall I always ask them to backup their request in Writing and tell them you will forward it on to the State Dept of Insurance in your state.

OR

Go ahead, gather all the claims, proof of submission report, confirmation of their receipt by UHC and a letter and send it right on to the State Dept of Insurance for your state.

It also wouldn't help to quote your state prompt pay/consideration law.

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