General Category > General Questions

Fradulent Change of Clearinghouse?

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Christy:
Has anyone ever heard of this?

My client uses Office Ally Clearinghouse since January. In the last 2 weeks, she has received emails from Medicare alerting her to fax and sign online  paperwork that was submitted for a change of clearinghouse for claims and remits.

We never submitted paperwork to Medicare to make these changes.

I called Medicare, and on both occasions, was told that the paperwork was filed by another clearinghouse/API company????????????

I called Office Ally to ask if they do business with this other company, and they do not.

anyone have any insight on this?

this other clearinghouse company has a website, etc and I will call them, but was hoping for insight here first?

thanks!

PMRNC:

--- Quote ---We never submitted paperwork to Medicare to make these changes.
--- End quote ---

Is it possible the client was signing up with another billing company or Office Ally ??   Did anyone request to see the original request to switch?

I've seen cases like this and turned out the provider was switching billing companies and didn't let the current billing company know. This is becoming more frequent with companies like office ally, Kareo, etc having their own billing companies and scooping up providers (no non compete, and even if there was they don't hold up in court).

I'd say REQUEST the actual change request.. see what happens.

Christy:
thanks, Linda. The provider got the emails personally and asked me to follow up with Medicare. She forwarded me the emails that she got from Medicare.

She is as bewildered as me and asked me to call the company that requested the change.

Medicare was not as responsive as I had hoped, as they insinuated the same, that she's switching billers behind my back....but Medicare did give me the name of the clearinghouse requesting the switch.

Christy:
I did ask Medicare if they could provide a copy of the change request and they said no. The online part was done, but the part that the provider has to sign and fax was never done....so the changes were never made, but this is creepy, nonetheless!

PMRNC:

--- Quote ---I did ask Medicare if they could provide a copy of the change request and they said no. The online part was done, but the part that the provider has to sign and fax was never done....so the changes were never made, but this is creepy, nonetheless!
--- End quote ---

I don't want to make a bad assumption, but it wouldn't be first time a provider did this NOT understanding they cannot have two submitter ID's.. BUT it could also be possible some other entity requested a change, and in error it was your client. .. I'd have to scratch my head on that one too. I'd say if nothing was changed and all is fine.. just keep doing what your doing. WHAT I would do however is make copies of the coorespondence from them and have provider write a letter stating that they did not make a change request and to please update their records to reflect that this was an error of some sort and to CONFIRM this with you. PUT it in writing so you have a record, and make a tickler file to follow up. Send it to your MAC CERTIFIED return receipt.   If your provider is unwilling to do that.. well maybe ..just maybe she is making a change and really didn't know you couldn't have two submitter ID's. good way to call her bluff and find out intention at the same time, if it was an innocent mistake you can make sure the record is accurate with Medicare.

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