I bill for a NY LMHC. She is INN with Value Options for MVP commercial only. She is OON for NYSHIP via Value Options. She could not be INN for NYSHIP/ VO even if she wanted to be, as they don't credential LMHCs.
She has been seeing a few NYSHIP people for years. They pay her full fee upfront and we submit the claim as a courtesy not accepting assignment. NYSHIP always pays the patients directly. It's been working great for years.
In August, when she re-credentialed with VO, someone over there must have accidentally checked the "NYSHIP" box. She got a letter that she was "credentialed in error" with NYSHIP and would be "disenrolled Oct 29."
Now her claims for Aug and Sept (and probably Oct) are being processed in network and at the NYSHIP/VO dismal fees ranging from $38- $67. Her patients already paid her normal fees upfront of $110- $150. They've all met their OON deductibles and are expecting their 80% reimbursement checks.
We have called the credentialing dept NUMEROUS times and keep being told we need to wait for someone from the "NY Team" to call us back as they are very backed up.
The LMHC never agreed to a NYSHIP contract and never agreed to their fee schedule. Besides appealing the claims to the claims dept (and we all know the claims dept and the credentialing dept have no idea what the other do), what steps/ recourse can we take?
this is a ridiculous situation, and no one at VO will listen to our point of view and someone (either the provider or the patients) are going to lose a lot of money