Paragon Billing, LLC

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me

[redacted] Mediation Coordinator [email protected]: ###-###-#### Our office has been in constant, weekly communication with both the individual provider and the owner of the facility with regard to the challenges that have been experienced by the clinic We have been up front regarding delays in payment postings which are the result of delays due to staffing on our part, as well as improper or erroneous information provided to us by the insurance payer While we have been able to control the staffing concern, the insurance payer issues persist and the clinic has been notified on numerous occasions of the status of the resolution to payer issues The payer issues are detailed below: Small carrier that only accepts mail, send claim information multiple times via mail I suggested mailing the claim directly to you so you can mail and see for yourself.Properly billed the claim however, the carrier processed the claims incorrectly, have submitted corrected claimsThis is an issue with the carrier, UHC ERA shows no payment, however, your clinic was receiving paper claims which were not submitted to us We are continuing to process data for DBT Associates and have given them an anticipated date of 6/10/in which all outstanding data will be completed on our end That date was provided to them two weeks ago and will align with their month end closure as well as payroll reporting on their end

There was consistent communication with the client and Paragon prior to the complaint and a member of Paragon showed how the amounts were derived on 12/8. At any time, the client was able to access detailed billing reports including total AR, amounts used to determine final bill,
denial reasons, total collections and claims needing further information from the client. Monthly invoiced amounts are determined based on the amounts posted as cash collections per the terms of the contract. The final bill was also calculated in accordance with the terms of the contract. Paragon offered a prompt pay discount that was not exercised by the client. The client offered a partial settlement on 12/8 that was declined by Paragon.Dustin's assertion that Paragon provides no follow up is grossly inaccurate as every unpaid claim is followed up at the day mark to determine the status. Dustin is correct that the client is not able to see all actions taken by Paragon to get the claim paid such as date submitted, resubmissions, billing notes from communication with payer. Paragon has future plans to push that information out to the client via portal. Paragon has a strict AR policy for any clients with old outstanding balances and as of the date of this response, Dustin has a past due balance that will be pursued

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

I am rejecting this response because: Paragon Billing has failed to fulfill business requirements for bill submission and crediting payment to client accounts.  The MN DHS web site references “Kickbacks and other criminal activities”, stating:  “A vendor who commits any of the following acts may be convicted of a felony and fined up to $25,000 or imprisoned for up to five years, or both:  ……  Receives payments for the benefit of another and knowingly uses them for a purpose other than on behalf of the beneficiary.”  Here is the message I sent to Paragon Management via Paragon Support function on 6-9-17 at 18:11:38 as an example of an account that is still not current as of 6-13-17, despite the business claim in their response to this issue that all client accounts would be up-to-date by 6-10-17.  There are other accounts too numerous to mention here that are also not up-to-date, including the AARP and Medicare funds mentioned in the initial complaint:Hello,I spoke with BCBS representative Maze (###-###-####) at approximately 4:22 pm 6-9-17.  Maze informed me that an EFT transfer of $2,929.08 was completed to DBT Associates bank account on 4-27-17 under unique transfer identifier number 2[redacted]005807 as payment for services provided DBT Associates clients.  Nearly 45 days have elapsed since payment was deposited to DBT Associates bank account and these paid funds have not been credited to some of the client's' balance due.Credit to client accounts is overdue and needs to be processed immediately.In addition, Maze informed me that BCBS has not received claims for any DOS provided to my client in May; no May claims were received for either group or individual service provision by DBT Associates.  This insurance provider has a TIMELY FILING deadline and my expectation is that these missing claims will be promptly submitted upon this notification.  Regards,Judy [redacted]

[redacted] Mediation Coordinator [email protected]: ###-###-####  Our office has been in constant, weekly communication with both the individual provider and the owner of the facility with regard to the challenges that have been experienced by the clinic....

 We have been up front regarding delays in payment postings which are the result of delays due to staffing on our part, as well as improper or erroneous information provided to us by the insurance payer.  While we have been able to control the staffing concern, the insurance payer issues persist and the clinic has been notified on numerous occasions of the status of the resolution to payer issues.  The payer issues are detailed below: Small carrier that only accepts mail, send claim information multiple times via mail.  I suggested mailing the claim directly to you so you can mail and see for yourself.Properly billed the claim however, the carrier processed the claims incorrectly, have submitted corrected claimsThis is an issue with the carrier, UHC ERA shows no payment, however, your clinic was receiving paper claims which were not submitted to us.  We are continuing to process data for DBT Associates and have given them an anticipated date of 6/10/17 in which all outstanding data will be completed on our end.  That date was provided to them two weeks ago and will align with their month end closure as well as payroll reporting on their end.