Capitol Administrators, Inc.

I actually put my responses in the review section and I thought they were going to be moved over. I want to make sure there is a record of response. At the time of my first response the only claim on file for this member was one in which the date of service was after the termination date. We then received additional claims directly from the Employer group. I updated the review and had to contact the member due to some questions I had on the claims. I spoke to the member, verified a primary insurance had paid $of the $and the outstanding balance was $65. Included in information from the Employer was another claim for $30. At this time both claims are being processed

The EOBs proving that *** *** approved the claims are attachedPlease disregard the EOB for services provided by Dr***These were paid appropriately

*** *** is the entity the employer (whom is self-funded) has contracted with to process their claims. *** does not issue payments on any claims until those funds are received from the employer. Thus, when those claims are completed the employer is responsible for the payment of the claims. Meaning they are notified of the claims pending payment, the employer then would send funds to *** to release the claims processed. Therefore, until such time monies are received, claims are pending a release of funds. As for the receipt of an EOB (explanation of benefits), one is available, identifying potential processing, but would not be valid until such time the claim(s) were authorized by the employer for payment/release. At this time, the claims in question have not been approved by the employer for funding. Payment of those claims would require the employer approve the check runs pending funding. Thank you and have a great day. *** ***Director of Operations

[redacted] Administrator is a TPA providing services for self-funded groups. The employer group Ms. [redacted] was with at the date of services for the claims in question, is responsible for funding those claims [redacted] Administrator processes. To date there is no funding to release the claims.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

The Employer group submitted an e-mail yesterday evening with the 6/6 and 8/8/2016 dates of service. I need additional information and will reach out to the member.Contacted member on 5/26. Verified the amount due is $65 for the 6/6 date of service as another carrier paid $50. The 8/8 date of...

service is for $30. Both claims will be processed accordingly.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.
This is 100% untrue. My attorney had also sent demand letters in addition to my submissions for all of the dates of service that I had provided. I have copies of all of those as well as my initial submissions and dates wrote on my calandar and also in addition to my submissions and my attorneys letters of request that SHOWED all dates of service INCLUDING the first 2 dates while still employed [redacted] corporate office took the time TWICE to forward the information including the original dates of service to them. [redacted] corporate office stated that capitol administration had said that I filled out the incorrect forms which I was provided the forms by the representative at their office. Very poor service and very poor solutions. Nothing was done until I reported this to the Revdex.com

First of all we would like to apologize for the inconvenience this may have caused and it’s not our intention to delay anyone’s payment on services rendered.  One of the requirements of the Affordable Care Act is that we provide electronic means of payment. The virtual master card meets that...

standard. I understand that as merchant you required to pay fee to process various credit card transactions and this is why we provide you with option to continue with the virtual card or opt-out and receive your payments via paper check. In this case we have opted you out of the virtual card back to receiving paper checks. Our ePayable product is part of the parent company [redacted] which North American Administrators and Capitol Administrators are subsidiaries of [redacted] no time was your payment being handled by a third-party or outsourcer. Again I apologize for the delay in converting your payment from Virtual Card to Paper Check and understand per your complaint that you have not received your payments for these claims. I would like to address the turnaround timeframe and provide you with some additional insight on when a provider opts out of the virtual card to paper check. Once we are notified that the provider wants to opt-out, we then request the funds back from our Master Card sponsor. This is the step in the process that you experienced most difficultly and since then has been addressed and corrected. Again my apologizes for the inconvenience you experienced in this process.  I have had your check reissued and it will be mailed this week. If you have any questions or need anything additional, please feel free to contact me.  Sincerely, [redacted]@capitoladm.com