Billing > Billing
MultiPlan? Heard of it?
thatcuteblonde:
I work for a mutlidisciplinary clinic including chiro and just went through a similar situation with Multiplan and UHC. Multiplan merged with PHCS so companies like UHC, regardless of your non-par status. We've been taking a huge hit on our claims since March 1st, they went to a percentage of Medicare's fee schedule and as a non par provider you're getting a lower percentage to begin with. This also keeps you from being able to collect more from the patient. On the majority of our claim's we're losing about 50% to reductions that we're obligated to take then another 30% as a non par provider. It's not worth it to us!
If you're contracted through FHA (Family Health of America) you can contact them to have your claims through UHC reprocessed however if you're contracted individually, you cannot do much about it. The catch is terming your Multiplan contract will not only take 90 days (!!!) but will also term your PHCS contract, though you should definately consider it.
Verifying benefits won't change or prevent anything in these cases since UHC only quote their benes, not the multiplan reductions since they are a seperate entity. Carefully review your contracts and weigh the pros and cons of remaining contracted. If your docs decide to get out of their contract, make sure that you term their group, individual and any other affiliated group contracts, especially with the 3 month term clause or you'll keep seeing this loss of revenue for quite some time. Best of luck!
Pay_My_Claims:
Multiplan works like this:
Patient has Empire Plan (NY state employee) His prof services are with UHC and tech with BCBS. If he goes to a par provider with UHC his benefits are whatever they generally are 80% ucr with his ded/copay etc. If he goes to a non par provider but par with Multiplan then his benefits can still be 80% based upon DISCOUNTED charges. EX a physical cost 200.00 they allow 150 and pay 80% in net work (UHC) non par but participates with Multiplan you can they will pay 80% but discount the physical to 100.00.
Again the key is verification. They do not pay your claims as if you are with multiplan when you are not. If you are a UHC provider and they do this, you should contact them and appeal the payment. Before multiplan pays you, they will send you an agreement to accept payment in which you can decline if you are non par like we are.
Hope this helps everyone, but if now, please google multiplan and you can get tons of information direct from them
thatcuteblonde:
There are two portions to Multiplan, the discount version which goes claim by claim and is based on a signed agreement and the portion of Multiplan which is a 'PPO network'. Either way the payments never come directly from Multiplan, they come from the insurance company, usually United. With the first type you receive a fax asking you to decrease your fees in exchange for prompt payment, legally they are required to pay your claim within 30 days, so these agreements benefit only Multiplan. The second type has basically forced many providers to accept the out of network percentage on the in-network rate, which results in lost revenue.
The insurance company, in most cases UHC will not tell you that your claims will be processed through mutiplan, they will simply quote the patients out of network benefits. For example as a standard out of network provider, you bill $150, they allow $120 and pay 70% i.e. $88.00 and you can bill the patient as you see fit. Through Multiplan, they take the same $150.00 charge and reduce it to $75 then you receive 70% i.e. $52.50 and are forced to write off the other $75.00. PHCS/Multiplan just reduced their fee schedule, so you could be losing more money than you realize.
Pay_My_Claims:
--- Quote from: thatcuteblonde on April 23, 2009, 02:45:14 PM ---With the first type you receive a fax asking you to decrease your fees in exchange for prompt payment, legally they are required to pay your claim within 30 days, so these agreements benefit only Multiplan.
--- End quote ---
Yes, we get these all the time and decline to accept the agreement. We are OON with UHC so we can balance bill the patient. If the client has a secondary claim, (especially medicaid) we just allow them to pay us OON and drop the balance to them. If we accept the payment, they will code it as payment in full and yes we lose money that way.
Plupiek:
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