Payments > Insurance Payments
The "Where to send claims" runaround!
QueenAlicia:
--- Quote from: DMK on January 28, 2011, 03:49:59 PM ---Here's the latest episode in my saga.
I had an Cigna claim, administered by APWU. I looked up the claim on the CIGNA site, a note popped up that this patient's claims were administered by APWU and to call them with questions at 800 xxxxxxxx.
I called APWU, got a really nice lady, she says "We don't have any claims on record for this patient, from this provider". I've sent the claim electronically 3 times (I have the e-claim acceptance receipt from CIGNA) and 1 time on paper. She says "Well let's get CIGNA on the line and we'll find the claims."
She sets up a 3 way conference call with me and CIGNA. The claim rep at CIGNA says "Yes, here are the claims, the provider has to send the claims to ASHN for pricing. They should have known that." So I say "There's been NO notification to APWU, NO notification to us, there is NO note on the site that they ask us to use instead of calling, how am I supposed to know there's anything amiss with the claim?" She says, "I can't answer that." The APWU rep says "Why weren't we informed that you were requiring the claims to go to another party other than CIGNA?" The CIGNA rep can't answer that either. So an investigation is underway.
Wow. How hard would it be to put on the CIGNA site (that they would really appreciate the providers using) where to send claims? I am logging in with a tax ID so they know who I am, and what our contract is. I guess it's just another crack in the system! Hopefully other providers will benefit in the future by having the CORRECT information on the site they would like us to use to reduce call volume.
So, I'm billing a 5th time to the 4th party for pricing. I may get paid before a year is up! :-\
--- End quote ---
Thanks for sharing this. I hope they pay you before the end of the year.
Pay_My_Claims:
--- Quote from: DMK on January 28, 2011, 03:49:59 PM ---Here's the latest episode in my saga.
I had an Cigna claim, administered by APWU. I looked up the claim on the CIGNA site, a note popped up that this patient's claims were administered by APWU and to call them with questions at 800 xxxxxxxx.
I called APWU, got a really nice lady, she says "We don't have any claims on record for this patient, from this provider". I've sent the claim electronically 3 times (I have the e-claim acceptance receipt from CIGNA) and 1 time on paper. She says "Well let's get CIGNA on the line and we'll find the claims."
She sets up a 3 way conference call with me and CIGNA. The claim rep at CIGNA says "Yes, here are the claims, the provider has to send the claims to ASHN for pricing. They should have known that." So I say "There's been NO notification to APWU, NO notification to us, there is NO note on the site that they ask us to use instead of calling, how am I supposed to know there's anything amiss with the claim?" She says, "I can't answer that." The APWU rep says "Why weren't we informed that you were requiring the claims to go to another party other than CIGNA?" The CIGNA rep can't answer that either. So an investigation is underway.
Wow. How hard would it be to put on the CIGNA site (that they would really appreciate the providers using) where to send claims? I am logging in with a tax ID so they know who I am, and what our contract is. I guess it's just another crack in the system! Hopefully other providers will benefit in the future by having the CORRECT information on the site they would like us to use to reduce call volume.
So, I'm billing a 5th time to the 4th party for pricing. I may get paid before a year is up! :-\
--- End quote ---
When calling for benefits, do you ask for the claims address??
medauthor:
--- Quote ---When calling for benefits, do you ask for the claims address??
--- End quote ---
Even with a claims address, they may still forward it to someone else for pricing :(
Pay_My_Claims:
agreed, because Medcost itself is a repricing agency. When you call for benefits, they ask are you contracted. If you are you send it to Medcost for repricing, if you are not, it will go to the insurance carrier. from what I get off the post, she just looked at the info on the website.
DMK:
I do verify where to send claims, we are contracted, I sent the claim where they said to send it, and I STILL got the run around. APWU was very understanding, and very interested to know what was happening to their claims (CIGNA was the claims processor, APWU was the administrator).
I did more research with ACN/ASHP (the pricing company) and they didn't list CIGNA as one of the companies who were contracted with them. So frustrating. And (I'm going to whine again) I will send the claims wherever they tell me...just quit changing the place!!!!!
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