Payments > Insurance Payments
The "Where to send claims" runaround!
Michele:
Interesting! I usually put in id# 00000000000000000 which they ask for repeatedly because they can't locate that id #. But eventually I usually get transferred to a live human! I may try supercalifragilisticexpialidocious!
DMK:
Does anyone else find it sad that we have to come up with ways to "fool" the computer to get to a live person?
I try to be clear and concise with the computer so that when I finally do get a person they will have all the correct information right in front of them. Then you get the operator from overseas that you can't understand, who can not seem to pull up the information you so diligently entered, who can't answer your question anyway! How many millions of dollars does this inefficiency cost the insurance company? I'll bet it saves them money by billers getting frustrated, hanging up, and not pursuing the claim at all! ARRRGGGHHHH !!!!!!!
I'd get fired if I did my job like that!
PMRNC:
--- Quote ---helpful hint. If you are trying to reach an actually person at any insurance company and only get the machine run around, try hitting 0 over and over again. Or my favorite evertime they ask for info say supercalifragilisticexpialidocious. The computer wil become confused and say. I'm sorry I cannot understand you and transfer you to a person..
added bonus. people walking by your office will think you finally had on claim to many to deal with
--- End quote ---
Ahhh...but on the flip side of this, i worked as a claims examiner for 3 MM carriers and with 2 of them, claims examiners did NOT have to do customer service.. so many times hitting that zero bounced you around and well, let's just say when you are working on production/quality.. it's annoying and many times you won't find it's beneficial to piss off the claims examiners. LOL I usually call provider relations and ask for a representative.. works everytime.
DMK:
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! :-\
Alice Scott:
It's good for beginners to know that this type of thing happens. When it happens to you for the first time you have no idea how far you will have to go to get this claim paid. Many offices let a thing like this fall thru the cracks and never get paid. Some think that it's not worth the bother. I congratulate DMK on taking it this far!!
Many of our readers are beginning medical billing services and you need to know that this is how you convince dotors to allow you do their billing - by going the extra mile - by collecting everything. Let them know that you don't let these things slide by. Even if it does take a year to get the claim paid, it does need to get paid and you can differentiate your service by going to these lengths.
Sorry... I've been doing so much writing for our new marketing program lately that I couldn't answer that post without offering a marketing tip.
Alice
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