Payments > Insurance Payments

The "Where to send claims" runaround!

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Pay_My_Claims:
@ DMK....i feel your agony (hug)

PMRNC:

--- Quote ---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!!!!!
--- End quote ---

What's even MORE aggravating is when you go through all of that only to find out the patient had EAP visits to use first and you just sent it to major medical who sent it or told you to send it to the mental health TPA... and you have just violated privacy.. all in the name of trying to do the right thing in the first place!  I always blame the verification/authorization line because when they know it's mental health they are supposed to first see if the patient has EAP!  I've had this happen a few times!

DMK:
When I call the insurance company to inquire about claims that seem to have "disappeared", is there a better place to go to rather than just "claims"?  Would provider relations be the better option?

This CIGNA and United HealthCare fiasco is about to break me!  We keep getting more of these patients, and I can't get good information from the insurance company.

Any suggestions?

rdmoore2003:
This CIGNA and United HealthCare fiasco is about to break me!  We keep getting more of these patients, and I can't get good information from the insurance company.

Any suggestions?
[/quote]

If you have contacted customer service reps and claim reps, you may want to speak with your provider relations rep.  This is part of why they are there, to help.  Now with that said, I have found these reps to be sometimes alot more difficult than the actual customer service reps.  I suggess to continue to document everything and everyone you have spoken with and keep "climbing the latter".   Rep, to supervisor, to their supervisor, etc.   

Now, last week I called Medicare with a similar issue.   I was told they no longer have provider reps and they no longer travel to a providers office.  You must give them the patient information and they forward that information to a rep that will call you within 14 business days.   DO NOT LET THIS BREAK YOU!!! 

PMRNC:
I have a policy I implemented in my P&P. If I have billed a carrier twice for any claim and they claim NOT to have received it, I call the carrier, request a supervisor and request the name of someone I can speak to in regards to getting that claim to that person. I verify their name, and it goes right on the envelope. No sense wasting more claim submission fees! Oh and if I can fax it I do so again, to the attention of the person I am directed to fax it to.  I try to include a copy of the submission report when possible as well.

I do a lot of Cigna and UHC but usually if I run into this scenario it's just a matter of it being sent to wrong claims office as they have so many of them. Sometimes the verifications don't get to me to find that out right away. occasional.. with any carrier (no rhyme or reason) I will get the old "We didn't get it"  routine.

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