To Whom it may concern; I was recently given the information regarding the above complaint regarding patient *** *** I discussed this case with a representative, Gail, and we went over the case This patient originally presented us with her insurance card for services
A claim was submitted to her insurance for DOS 10/21/14, the response from the carrier on 11/21/stated this claim was processed by another payer We reached out to the member, via a patient statement to try to get updated insurance information, patient statements were sent 1/1/15, 2/5/15, 3/12/15, & 4/16/ At this time the patient responded by calling our billing office The issue was discussed with her, in which the patient stated she was going to reach out to the insurance to see what the issue with her insurance is. The claim was rebilled to the insurance, but was rejected due to timely filing A new statement was sent to the patient on 6/25/with a note stating we tried to run eligibility with *** but the eligibility came up ineligible Again, multiple statements were sent dated 7/30/15, 9/3/15, 10/8/& 11/12/ At this time the patient was put in collections. As my manager and I have reviewed this case, we did see that although the member did not contact us upon receiving the first couple of statements, which would have allowed more time for filing, the refilling of the claim in June should have been sent with a copy of the original denial, which may have prevented the timely filing appeal Due to these combined issues, we have contacted the collections agency and informed them to stop all collections process We are going to submit all the documents to the correct carrier to get the correct denial from the correct payer Once the claim denies for timely filing, we will adjust the balance off. This process may take a couple of months to finalize, as sending in a paper claim to the carrier can generally take about days to process, so please inform ***, she may receive some documentation from her insurance stating a claim was received for this service. Thank you for reaching out to us regarding this patient’s complaint, and for allowing us the chance to resolve this matter for *** We apologize for the inconvenience she has had to endure during this process
To Whom it may concern; I was recently given the information regarding the above complaint regarding patient *** *** I discussed this case with a representative, Gail, and we went over the case This patient originally presented us with her insurance card for services
A claim was submitted to her insurance for DOS 10/21/14, the response from the carrier on 11/21/stated this claim was processed by another payer We reached out to the member, via a patient statement to try to get updated insurance information, patient statements were sent 1/1/15, 2/5/15, 3/12/15, & 4/16/ At this time the patient responded by calling our billing office The issue was discussed with her, in which the patient stated she was going to reach out to the insurance to see what the issue with her insurance is. The claim was rebilled to the insurance, but was rejected due to timely filing A new statement was sent to the patient on 6/25/with a note stating we tried to run eligibility with *** but the eligibility came up ineligible Again, multiple statements were sent dated 7/30/15, 9/3/15, 10/8/& 11/12/ At this time the patient was put in collections. As my manager and I have reviewed this case, we did see that although the member did not contact us upon receiving the first couple of statements, which would have allowed more time for filing, the refilling of the claim in June should have been sent with a copy of the original denial, which may have prevented the timely filing appeal Due to these combined issues, we have contacted the collections agency and informed them to stop all collections process We are going to submit all the documents to the correct carrier to get the correct denial from the correct payer Once the claim denies for timely filing, we will adjust the balance off. This process may take a couple of months to finalize, as sending in a paper claim to the carrier can generally take about days to process, so please inform ***, she may receive some documentation from her insurance stating a claim was received for this service. Thank you for reaching out to us regarding this patient’s complaint, and for allowing us the chance to resolve this matter for *** We apologize for the inconvenience she has had to endure during this process