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Billing for Florida provider...

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Pay_My_Claims:
Yeah thats great, just hard for us to do on high-end DME

Michele:
Florida BC tells all specialties that they are not accepting any more as far as I can tell.  If you have anything that makes you different from any other PT, such as a specialty like post stroke victim using dog therapy (obviously an example), you can appeal stating you are unique but it's still not a guarantee. 

First Coast Service Options are one of the most difficult Medicare Carriers I have ever dealt with.  For credentialing anyway, not for claim payment.

Availity is just one of many clearinghouses.  Like Linda said, you need to see what your software is compatible with.

Michele

Pay_My_Claims:
Hey Linda, since you are the previous insurance worker...what would be a reason a carrier would close its network?? I would think they want more providers in network with them.

Michele:
I've always wondered the benefits of closing the network as well.  I can see the benefit to the providers that are in the network, but not for the insurance carrier, except that they have less providers to maintain.  I had BC of NC tell me that they close the network "to protect the providers they have" but again, that doesn't really make a lot of sense to me.

Michele

PMRNC:
They have an internal CAP on network providers by network and then by geographic location. It has something to do with Risk Analysis..the more providers they have the more they pay out.. lol  that's it simply  :o

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