Sage Social Services

Presented below is a summary of what took place regarding this client's referral.1.       Sage took referral2.       Sage verified clients benefits as in-network3.       Client was seen by [redacted]...

[redacted]4.       Billing was submitted as in-network5.       11/9/16  - Humana Rep contacted Sage to confirm we were in –network with Humana One - San Antonio HMO-X Plan , Sage referred them to call SV Billing Solutions6.       11/9/16 - Humana Rep reached out to SV Billing Solutions regarding network statuso   [redacted] spoke with Human Rep, rep asked our network status with Humana One - San Antonio HMO-X Plan (Exchange Plan).  [redacted] could not confirm in-network status with Humana One - San Antonio HMO-X Plan (Exchange Plan) until she spoke with a Humana Behavioral Health Provider Rep.  [redacted] stated she would reach out to Provider Reps to get an answer.  §  We were not asked or advised to call the client back.  o   [redacted] called and emailed numerous POCs with Humana Behavioral to get a network status regarding this plan but was bounced around.o   [redacted] called Humana One to re-verify benefits and to get the claim corrected as “in-network”§  Humana One Rep stated we WERE in-network and warm connected us to Humana One claims department.§  Humana One Claims Rep stated we were NOT in-network.  §  Humana One Eligibility Rep and Humana One Claims Rep “disagreed” on network status, could not come to an agreement on if we were or if we were not.  §  Finally the Humana One Claims Rep stated we were NOT in-network with Humana One - San Antonio HMO-X and claims would not be re-processed as in networko   [redacted] called to get claim corrected and was informed of the same, told to reach out to Provider Relations7.       At this moment [redacted] has still not heard back from Humana Behavioral Health to help clear up this issue regarding our status.  NO emails, faxes, or phone calls have been returned by any Humana One Rep. [redacted] just called Humana Behavioral Health (again) and they informed me we are in-network.  Ariel (Humana Behavioral Eligibility Rep) offered to conference in a call with Humana Medical Claims and have the claim adjusted.  Per the Humana Eligibility Rep, at times their Humana Medical and Humana Behavioral do not list the same providers as in-network but they can fix that issue on the phone.  Humana One Claims Provider Rep (Rain) stated he will correct the claims, the corrected claim will be “escalated” since this is the third time SV Billing called on the claim and it was not processed / corrected the two previous times.  Please allow 7-10 business days to correct the claim.  (Reference # 594590550512) Since [redacted] had the reference # for her first call Rain submitted her negative feedback regarding the calls/claims to the Humana Claim Supervisor so a correction with the first rep can be made.  [redacted] was in-network as of 1/21/16 with this Humana Behavioral Health line of business under Sage. SV Billing never responded to the client because they were not advised to reach out to her and either way SV Billing has not heard back from Humana Provider Rep. SV Billing notes only show she paid the in-network responsibilities and nothing more or excessive.Furthermore, Clinical Director [redacted] is calling and emailing the client back regarding this issue.