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Electronic Billing!

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medauthor:
Me venting here... I thought one of the benefits of electronic billing for us billers was that the ins co could not state " No claim on file"!!!  >:(

I have had 2 ins carriers in the past week state "No claim on file" and yet I have an acceptance report from both payers!!!

Pay_My_Claims:
KILL the insurance companies!!

PMRNC:
I have the same problem with a few claims from BCBS..just this week too!

Anand:

--- Quote from: medauthor on September 01, 2010, 06:00:54 PM ---Me venting here... I thought one of the benefits of electronic billing for us billers was that the ins co could not state " No claim on file"!!!  >:(

I have had 2 ins carriers in the past week state "No claim on file" and yet I have an acceptance report from both payers!!!

--- End quote ---
Persoanally it happened to me in few instances, coudnt remember the payor but when i told them that there has been an acceptance report. The ins Rep put me on hold and stated that it was there but due to some syst gltich they havent taken it into the adjudication system. Hence she has taken and assigned me with a ref#. In most cases when i f/u with clm they were paid..just a try before resubmitting the claim....:)

midwifebiller:
Unfortunately, this happens to us quite a bit.  Just this week I was on the phone with a rep who insisted the claims were not on file, when I had a clearinghouse report that stated claims had been received and accepted.  This was the second time these claims had been submitted and the member was very irritated with us, thinking we were not doing our job since she could not see the claims on the insurance company's website.  A few things that help:

Have the rep look in the EDI file.  There is some big, black hole where e-claims get lost, and they can usually be found here.  Most reps are unwilling to look here, but if you are persistent they will eventually take a look.

Ask to speak with a supervisor.  I don't have time for greenhorn reps or those who cannot speak fluent English.

Ask to be transferred to the EDI department.  They have found many of our claims and also identified the problem so that it (theoretically) does not happen again.

As for the above claims, the rep continued to insist the claims were not on file (end-of-conversation-please-hang-up attitude).  I told him again that I had an e-report, and that if he couldn't find the claims I needed to speak with his supervisor.  He finally checked the EDI file.  And found the claims.  When I asked what the problem was, I got: "Oh, it's just one of those little glitches.  The claim was not routed to the correct department."  Grrr.

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