Billing Errors

[Uandisolutions]

My practice uses Ability to bill insurance companies for patient sessions. I recently discovered that my former employee had set up the Ability account with the wrong "Billing Provider Info," where the Group NPI was listed instead of the Provider NPI. Unfortunately, since our Group NPI is not contracted/empanelled with Cigna (only my Provider NPI), insurance has been processing payments at the rate set for out-of-network services. This employee had been submitting claims in this manner dating back to 12/2018 totaling well over 150 incorrect submissions. If I am not mistaken, payments for each of the claims submitted to Cigna were at the rate of 20% of the charge amount instead of 100% of the charge/contracted amount minus the co-pay. Is there anyway that this can be retroactively corrected? If so, should we appeal the claims or resubmit them with the correct NPI listed? Lastly, is there a cutoff for how far back Cigna will accept appeals/re-submissions?

Any assistance would be greatly appreciated!

[kristin]

Cigna, for most policies, has a 180 day timely filing policy for appeals, based on date of initial claim payment. So while it looks like you are out of luck on the appeal front, I would contact your provider rep, explain the situation, and see if there is anything you/they can do at this point. Submitting a corrected claim probably won't work, due to timely filing issues also. This is an unusual situation, which is why you need a provider rep involved at this point.

My argument with the rep would be that the rendering provider was contracted with Cigna, even if the group was not, a huge mistake was made by the employee, claims were submitted incorrectly, and you would like them to be corrected at this time. Keep in mind if they do agree to do a mass readjustment on all the claims in question, they may ask for all the money back that was paid at the OON rate of 20%, before they reprocess at the in network rate.