Rice Express Alta Mesa

Enhanced Management Services, Incis a third party billing company whose client in this case is [redacted] Ambulance Mr [redacted] was transported by [redacted] and subsequently, a claim was submitted to his insurance company, [redacted] *** [redacted] *** sent a denial to Mr [redacted] as well as to Enhanced Management Services The denial sent to Mr [redacted] was quite different than the one received by Enhanced The denial received by Enhanced indicated that the patient was responsible for the claim because the service was not covered under his benefit plan (see attached) Based on this denial, Enhanced sent a bill to the patient After receiving our bill, Mr [redacted] began filing various complaints via e-mail, telephone and the Revdex.com However, when we received a copy of the [redacted] *** denial that Mr [redacted] forwarded to our office, which indicated something different than what Enhanced had received, a representative from Enhanced contacted his insurance company immediately in an attempt to clarify exactly what was going on with his claim Our representative was told that the claim was denied due to the fact that it was submitted with a modifier of "SHET" The Enhanced representative informed the [redacted] representative that the claim was NOT submitted with any such modifier and requested that an image of the original claim be retrieved and referenced The [redacted] representative did pull the image and found the claim did NOT have said modifier The [redacted] representative then sent the claim back for reprocessing At this time, we are awaiting final determination from [redacted] on the reprocessing of the claim As you can see, this was a [redacted] error Mr [redacted] was informed that this entire issue originated from an error on the end of his insurance company and that his claim is being reprocessed His final communication to Enhanced was to thank me for my assistance and has entrusted us as experts in our field to take care of his bill He indicates that the bill is covered by his insurance We have no way of knowing what his policy does and does not cover Once the final determination is made by his insurance company, we will be in touch with him to let him know what the determination was I have let him know that I am available to him to assist in any way possible.I have attached all relevant correspondence and insurance EOBs.If you have any further questions, please feel free to contact me directly at [redacted] .Heather D***, CAC, CAPO, CACOOperations Manager

Enhanced Management Services, Inc. is a third party billing company whose client in this case is [redacted] Ambulance.  Mr. [redacted] was transported by [redacted] and subsequently, a claim was submitted to his insurance company, [redacted].  [redacted]...

sent a denial to Mr. [redacted] as well as to Enhanced Management Services.  The denial sent to Mr. [redacted] was quite different than the one received by Enhanced.  The denial received by Enhanced indicated that the patient was responsible for the claim because the service was not covered under his benefit plan (see attached).  Based on this denial, Enhanced sent a bill to the patient.  After receiving our bill, Mr. [redacted] began filing various complaints via e-mail, telephone and the Revdex.com.  However, when we received a copy of the [redacted] denial that Mr. [redacted] forwarded to our office, which indicated something different than what Enhanced had received, a representative from Enhanced contacted his insurance company immediately in an attempt to clarify exactly what was going on with his claim.  Our representative was told that the claim was denied due to the fact that it was submitted with a modifier of "SHET".  The Enhanced representative informed the [redacted] representative that the claim was NOT submitted with any such modifier and requested that an image of the original claim be retrieved and referenced.  The [redacted] representative did pull the image and found the claim did NOT have said modifier.  The [redacted] representative then sent the claim back for reprocessing.  At this time, we are awaiting final determination from [redacted] on the reprocessing of the claim.  As you can see, this was a [redacted] error.  Mr. [redacted] was informed that this entire issue originated from an error on the end of his insurance company and that his claim is being reprocessed.  His final communication to Enhanced was to thank me for my assistance and has entrusted us as experts in our field to take care of his bill.  He indicates that the bill is covered by his insurance.  We have no way of knowing what his policy does and does not cover.  Once the final determination is made by his insurance company, we will be in touch with him to let him know what the determination was.  I have let him know that I am available to him to assist in any way possible.I have attached all relevant correspondence and insurance EOBs.If you have any further questions, please feel free to contact me directly at [redacted].Heather D[redacted], CAC, CAPO, CACOOperations Manager