General Category > General Questions

Release of info to 3rd party billing services

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ste:
The local state-chartered workers' comp insurance company has a policy to not release any patient information to 3rd party billing service companies. They make it very difficult for me to follow up on claims which I have submitted.

I always start out the conversation with, "I am calling from ......", but there have been times when the adjuster will say, "so and so from your office just called me about this claim and ....." At this point I just tell them that I am the contracted biller for the group of medical providers and they refuse to speak with me any further.

What is the best way to remedy this so I can follow up on claims? 

Sriram_Sub:
I think it would be good to send an authentication letter from your provider under the provider's letter head to any workers comp insurance you submit claims to. May not necessarily be needed to send it for every claim submitted but at least once to let them know that  you are approved to deal with the patient's claims on behalf of the provider. JMO.

ste:
I've offered to supply the insurance company with such a letter but the adjuster told me it would do no good.

PMRNC:
I do NOT receive the PHI in cases like this direct. I call and state what office I'm calling on behalf of and the information goes to the provider, what I need for billing he/she gives me. That is pretty simple, why fight it when you can just get the information from the provider directly. The carrier is correct in NOT sending you the information. ALL information I request from any carrier always goes to my client/provider. I DO not want it coming to me, let the provider send you what you need.

ste:
Somewhere there is a misunderstanding here.
I am taking about following up on a claim. For example, if I have the EOR in front of me and see that the procedure on line one did not pay because the adjuster couldn't find the information in the chart notes, then I call the insurance and point out to them where that information actually is on the chart notes. The adjuster sends the claim back for reprocessing, the procedure gets paid, and the provider is happy.
I realize Linda that you have the chart notes sent directly from the office to the insurance, so this might not be the best example.
My point is claims need to be followed up on. If I can't get past the the gate to follow up on claims, then way too many will go unpaid. 














 

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