Billing > Billing
Late Filing Appeal
DMK:
And the public wonders why doctors go out of business!!! Sorry you're having to clean up the mess. Just tell the doctor what the rules are about filing timely and that ANY payments you get should be considered gravy! What were they thinking by not billing? Oh well, some doctors are great doctors and horrible business people. You'll be the hero for filing the new stuff timely and getting paid fast!
Dina
PMRNC:
I always say "GO FOR IT" if you have nothing to lose. I used to be a claims examiner for 3 large carriers and we had a lot of administrative power, many times I would pay a claim regardless of late filing, maybe it was a nice day and I was in a good mood to make the administrative decision to do so. My motto is to at least give it a shot :)
Pay_My_Claims:
--- Quote from: PMRNC on April 03, 2010, 04:28:49 PM ---I always say "GO FOR IT" if you have nothing to lose. I used to be a claims examiner for 3 large carriers and we had a lot of administrative power, many times I would pay a claim regardless of late filing, maybe it was a nice day and I was in a good mood to make the administrative decision to do so. My motto is to at least give it a shot :)
--- End quote ---
That's sad that claims are paid that way. It shouldn't be at the "discretion" of an adjuster.
PMRNC:
--- Quote ---That's sad that claims are paid that way. It shouldn't be at the "discretion" of an adjuster.
--- End quote ---
Why isn't that fair? It's not like they see a claim that is within the timely filing period and they deny it, I'm talking about the times the adjuster looks the other way and allows something using their judgment. All of the big carriers work that way. The more experience and years you have in, the more administrative thresholds you have, flip it around, suppose a procedure was to be cut for U&C and the examiner was allowed to override it. See works both ways. It is fair. It keeps examiners honest by allowing them more control for earned experience. The alternative is that the claim gets denied, so why is it not fair?
Pay_My_Claims:
(Never mentioned not fair) No, I don't see the both ways in it according to what you posted. you said, you would be in a good mood and may let it slide. If the claim denied for timely filing, then I screwed up and I have to pay the penalty. The more you talk the more I feel justified in having investigations in insurance practices and procedures. Its no more right to pay a claim that should have been denied for timely filing, then to deny a claim because some adjuster is on their period. This is why you have contracts. If I follow the rules of the contracts, if I bill the claim timely and correctly, it should pay according to my contract and not some adjusters mood.
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