Medical Billing Forum

Billing => Billing => : DMK April 25, 2012, 02:32:10 PM

: Dr. is Shown Par but "Clinic" is not?
: DMK April 25, 2012, 02:32:10 PM

I'm having trouble with United HealthCare.  Since 1/1/12 my eob's are coming back showing we are Non-Par.  So some groups are paying and others won't (stating we are Non-Par).  When I called on one of the eob's that didn't pay, the customer service rep said that "Dr. XXXX is showing as participating, but XXXXXX Chiropractic is non-par".  The Tax ID is the same, the NPI is the same, the Dr. has always billed with the clinic name (as the clinic's name is the doctor's name) so why is it showing NOW as Non Par?

I was referred to provider relations.....who then referred me to Optum Health (because it's chiropractic) .......whose phone message just hangs up.  Is there any way around the run around?

Thanks for any help!

: Re: Dr. is Shown Par but "Clinic" is not?
: PMRNC April 25, 2012, 02:40:49 PM

I was always told all doctors have to be credentialed even if in group.

: Re: Dr. is Shown Par but "Clinic" is not?
: DMK April 25, 2012, 03:44:56 PM

There is no group, and it's an individual NPI.  There was NO change in our status from day one to now.

: Re: Dr. is Shown Par but "Clinic" is not?
: Michele April 26, 2012, 10:13:26 AM

If the billing is under an individual NPI why is "XXXXXX Chiropractic" on the claim?  If their is no group NPI the dr's individual name should be in 33 and 32.  Maybe this is the problem??

: Re: Dr. is Shown Par but "Clinic" is not?
: DMK April 26, 2012, 02:18:02 PM

Thanks Michele!!!! That's exactly what it was, and nobody but UHC cared.  I fixed it!