General Category > General Questions

Release of info to 3rd party billing services

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Sriram_Sub:

--- Quote from: ste on September 18, 2013, 04:47:04 AM ---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.
--- End quote ---

I just read your post again. The best way to handle this is that you make sure no one has called before you did so that you may not get that response from the Adjuster "So and So from your office....". Every time someone else (from the provider's office) follows up on the claim, they will have to make a note on the claim so it will be available for you to review before you decide to make a call. Also, as said by Linda, you could say that "I am CALLING ON BEHALF OF <the provider's name> (not "CALLING FROM <Provider's name> which might sound to be fake), instead of mentioning that you are the contracted biller for the provider.

PMRNC:

--- Quote ---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
--- End quote ---
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I was going by your very first sentence:


--- Quote ---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.
--- End quote ---

The policy of the carrier is NOT incorrect. For situations like that you have to just ask them what their procedure is and follow along. They are following their procedures. There are a lot of carriers that will not release info to 3rd party billing companies, they don't have to, your contract with your provider is NOT conclusive of any policy they have in place. That's why I say it's best to state your calling for so and so's office. If you already told them you were a 3rd party billing company and they implemented that policy , most likely they flagged this in their system. Call them and find out their exact procedure. You can also ask them if they will take a fax authorization from the provider and even add this to the file in their system. Worth a shot.

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