Help the insurance companies keep sending my claims back!
Healthcare providers now more than ever are getting handfuls of claims back in the mail. What's wrong? First, there is a deadline coming that affects all covered entities (providers, insurance companies and clearinghouses) by May 23, 2008. This is the date all covered entities must use the NPI numbers. (Remember the original date was May 23, 2007 but that was extended.) Because of the time crunch, everyone is struggling to get compliant.
So, why are the claims denied? There are a couple of reasons:
1) The NPI number isn't on the claim form.
2) The legacy numbers (old provider numbers) need to be removed from the claim form.
3) The legacy numbers need to still be on the form.
4) The insurance company and/or clearinghouse needs to have your NPI number(s) to update their system and/or contracts.
5) The provider is a solo provider billing under a corporate tax id number and needs to get a second NPI number.
To compllicate the matter, providers may be getting claim forms back from different companies and the answer can be different for each company. If you need help getting your claims paid, give us a call today at 888-322-2455 or 763-546-2455. Or, complete and fax back this support form. Happy Billing!
So, why are the claims denied? There are a couple of reasons:
1) The NPI number isn't on the claim form.
2) The legacy numbers (old provider numbers) need to be removed from the claim form.
3) The legacy numbers need to still be on the form.
4) The insurance company and/or clearinghouse needs to have your NPI number(s) to update their system and/or contracts.
5) The provider is a solo provider billing under a corporate tax id number and needs to get a second NPI number.
To compllicate the matter, providers may be getting claim forms back from different companies and the answer can be different for each company. If you need help getting your claims paid, give us a call today at 888-322-2455 or 763-546-2455. Or, complete and fax back this support form. Happy Billing!
We have not had a single Medicare claim paid when sending through Medavant/Phoenix Broadband. We use Medisoft Version 12 with the most recent Phoenix update. We have spent countless hours on the phone with both Medicare and the clearinghouse, and surprise, surprise, we get different answers every time. It would be helpful if someone would post a clean Medicare claim for review. It would be more helpful to get everyone on the same page.
Our particular practice is a sole provider billing under a group. We are a chiropractic practice, so our CPT codes are minimal and claims are relatively simple. If there is anyone who has successfully overcome this problem, please contact me at l_t_powell@hotmail.com
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Thank you for your comment. Here are a few tips to help you out. First, with any type of claim, you need to make sure the claims are getting to the payer. So, if the claims are on paper, you need the right address. If they are electronic, you need the right payer number and to verify Medicare is receiving your claims.
Next, here is a problem solving chart for your electronic claims. Step 1: Call Medicare and verify receipt of a couple claims. If they do not have the claims, call MedAvant at 800-689-4550 and they can track them down. Step 2: If Medicare does have the claim, there must be something wrong with the information entered on the claim. There are variances between specialties and states. You can go to your local Medicare carrier website and read the information for your carrier. For example: With chiropractic care, you need to have the PART date, level of subluxation, corresponding symptom/condition, modifier and facility in most states. Here is a sample chiropractic policy: Sample of Chiropractic Policy.
Billing has always been a puzzle to solve and you never know where the answers will come from. But, don't quit searching. You will get there and maybe some of our other readers will help you out. Or, we are always here to help you; just complete the support form and fax it back. Support Form Happy Billing!
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We have several clients in the medical profession that utilize us with both self pay and insurance pay accounts. Since we are a collection agency it is the RESPONDENTS duty to call YOU and tell you why the claim is not being paid.We typically move the days in receivables up by at least a month and since we are a flat rate company the cost per account is minimal and affordable. The average clinic can't afford to spend time tracking down claims when we will do it and get results.
If anyone reading this would like more information please contact me at alwent@wildblue.net
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I truly believe that it is the responsibility of the carrier and/or clearinghouse to contact the billing provider's office with the correct way to submit a claim when a major change (i.e. dropping legacy numbers for NPI only) is about to occur. Furthermore, it is entirely impossible to decipher the information on the CMS website. Is it so hard to post an example of a clean claim? Isn't the clearinghouse supposed to send along the information in the correct format to the carrier?
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Thank you for your comments. Medical billing is one of those potentially complex topics similar to taxes or legal issues. Sometimes you are able to work through the problem yourself and sometimes you need professionals. If you are stuck, that means your money has slowed. It might be time to get some help. If we can help, please call us at 888-322-2455 or complete and return this form.
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