Billing > Billing

MultiPlan? Heard of it?

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wardchiro:
Has anyone heard of MultiPlan and billed for it? How does it work? We are a chiropractic office that is in-network with MultiPlan, but out-of-network with UnitedHealth.  We have a patient with UHC insurance that we are charging/billing as out-of-network. This patient got an EOB stating that we owe her $200 because we should be billing at the UHC contract rate since we have a contract with MultiPlan.  We have no contract with UHC, just MultiPlan.  Can anyone help???? Thanks!!!

Michele:
I have actually had a similar situation with UHC.  If you par with Multiplan and they are stating that your Multiplan contract applies to this patient then you have to honor that.  I would call UHC and make sure that is what is happening and ask how you would know that this is a Multiplan member for the future.

Michele

Pay_My_Claims:
UHC does utilize Multiplan as a "complimentary" PPO Network. They have also joined with PHCS. Although you are OON with UHC being a network provider of multiplan, you have to bill the patient as in Net since Multiplan is one of the networks that UHC utilizes. It is such a key factor when verifying benefits. Client comes in with MegaLife, we are OON, but use PHCS as the PPO network, we are contracted thus the patient is in network with us. Hope this helps.

mellisaj:
I have seen this occur recently for our pediactric PT/OT client.  I did some research on it and basically there is no way to tell if the claims will be priced/processed through Multiplan just by looking at the card.  My client does not par w/ One Net (formerly MAMSI/Alliance) - so, if they have One Net - we've been treating them as OON (billing the 3rd party payer directly and balance billing the patient the difference). Well, when the EOB came in - it was processed via Multiplan and we had to honor it.  I called Guardian (the 3rd party payer) and spoke to a supervisor.  They told me that this is a new way for them to handle OON claims.  They search for a 'complimentary network' that the provider DOES par with and then re-route the claim to price through them.  It benefits the patient b/c they pay less out of pocket and it benefits the payer b/c their contractural fee schedule now applies.  Basically it's a very sneaky way to get our claims processed in network!  So - now my clients are going to drop Multiplan and PHCS! It's crazy!

~Mellisa Jiron
IMS, Inc.

Pay_My_Claims:
The key again is VERIFICATION!!! It is the first and most important step in the billing process and saves valuable time and money. Knowing how a claim will pay and the benefits of the policy saves providers tons of money and grief. Coming from ins. verification I know what to ask and how to get the answers i need to determine patient benefits, ded, coins, and if auth is req.

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