Author Topic: ques re:3rd party repricer Multiplan and Data ISight tactic  (Read 5322 times)

gesheva123

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Re: ques re:3rd party repricer Multiplan and Data ISight tactic
« Reply #15 on: June 21, 2021, 05:43:51 PM »
We are out-of-network PT provider in Manhattan

If Data Isight has a failed negotiation with the provider (provider refused to accept the repriced/discounted claim), Cigna will reprocess claim based on their member's plan benefit. This takes time but at least we get paid properly.

Aetna - only started with Data Isight this year. Also, Aetna created a National Advantage program (NAP) seen in almost all Aetna ID card. NAP triggers OoNet claims to be sent to Data Isight for repricing. I managed to disconnect our Tax ID to that program and our claims were reprocessed accordingly but that didn't last long. As of May, our claims are being sent to DI again and according to some Aetna claims supervisors, I was given the wrong information.

My office is looking for legal advice on how to dispute DI discount at this time. We can all help each other!

How did that go?

I don't think you have to agree at all but perhaps it takes longer to collect. Would you prefer to accept DI offer or wait for higher/amount per patient's benefit plan? In your view, what do most providers choose?

Michele

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Re: ques re:3rd party repricer Multiplan and Data ISight tactic
« Reply #16 on: June 21, 2021, 09:46:19 PM »

How did that go?

I don't think you have to agree at all but perhaps it takes longer to collect. Would you prefer to accept DI offer or wait for higher/amount per patient's benefit plan? In your view, what do most providers choose?

Most of the providers I know wait for the patient's plan to process.  Personally I don't see it as taking longer.  I always tell providers not to negotiate because usually the patient has a deductible and the patient is responsible either way so there is no benefit in agreeing to the lower amount anyway. 
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Re: ques re:3rd party repricer Multiplan and Data ISight tactic
« Reply #16 on: June 21, 2021, 09:46:19 PM »