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Insurance Carrier Management

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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asears

(@asears)

Posts: 49

Trusted Member

Topic starter

Hello,

We are trying to consolidate our insurance carrier list by payer ID to reduce the confusion and effort of our front office and call center staff of selecting the appropriate carrier. We have 10+ insurance carrier options it seems per payer, and I would like to drop it down to a more manageable level (ie. Regular, Medicare, Referral Required, etc.) for all those that have the same payer ID for claims and eligibility.

When bringing this to our billing department's attention, they've voiced a few concerns. I'd like to see what other practices are doing and how they are handling these concerns:
1. Claim re-submissions/corrections are still going out on paper and need each carrier's individual PO Box/address
2. Not all carriers accept secondary claims electronically
3. It would be difficult for A/R to follow up with the payer without the insurance contact information readily available
4. A/R finds it helpful to know the type of insurance (HMO vs PPO, etc) because they know that certain types will pay/respond certain ways

The payers we are specifically looking at are: Anthem/BCBS, Aetna, Cigna, Connecticare, United Healthcare, and Oxford

Any input would be greatly appreciated.

Thank you!
Bree

Posted : February 26, 2018 10:36 am

Michelle

(@michelle)

Posts: 38

Eminent Member

Hello Bree:

We also have lots of insurance carriers with the same Payer ID. Our billing staff offers the same concerns that your's does. They do need the actual address if the claim goes on paper and yes, the phone number to call does vary depending on the plan group, so we leave all insurances as is and keep on adding more if needed.

I know this is probably not what you want to hear since the management of these insurances is overwhelming AND whenever GE makes a change that affects them I have to change each and every one individually!! You would think that GE would come up with a way that at least allows you to make the change to the group or financial class instead of having to manually update each individual insurance.

Anyway hope this helps.

Michelle

Posted : February 27, 2018 1:56 am

Crandall70

(@crandall70)

Posts: 5

Active Member

Hi Bree,

I understand their trepidation, however, I have been recommending the consolidation of carriers to all of my clients. As you stated, it is immensely helpful to the front office and call center staff.

In response to your billing department’s concerns:

Do they know claim re-submissions/corrections can go electronically? They can make the necessary corrections, enter a “7” in the Resubmission code field, enter the original claim ICN in the appropriate field and send the corrected claim electronically. If the carrier does not accept electronic resubmission, use the carrier’s form (many have their own) or develop internal forms and have them available on a shared drive. Also, some carriers allow resubmission through their provider portal.
Although it’s true that not all carriers accept secondary claims electronically, this is the rarity and not the norm and should represent a very small percentage of your business.
It should not be difficult for A/R follow up with the payer as most is done online these days. If you are not currently doing follow up online, I highly recommend registering on your payer’s site or other sites such as Navinet, Availity, etc. If you need to actually call the carrier, the phone number is on the ERA/EOB; which in most cases staff are already viewing.
Knowing the type of insurance (HMO vs PPO) is helpful, but again as they are working the claim this is typically apparent. They can either tell by the member ID, insurance card, EOB/ERA, or carrier letter.
In regards to the payers-
1. Anthem BCBS-there is information on their state site and Anthem typically uses Availity as their provider portal. https://www.availity.com/
2. Aetna-there is information on their general site and they use Navinet as their provider portal. https://navinet.navimedix.com/sign-in?ReturnUrl=/Main.aspx
3. Cigna-uses their own site https://cignaforhcp.cigna.com
4. Connecticare-uses their own site https://www.connecticare.com/provider/default.aspx
5. United Healthcare-uses their own site (you need to have an Optum ID to sign in). https://www.unitedhealthcareonline.com/b2c/CmaAction.do?viewKey=PreLoginMain&forwardToken=PreLoginMain
6. Oxford-uses their own UHC Oxford portal. https://www.oxhp.com/ProviderPortal/

In my opinion, the pros outweigh the cons. When performing A/R follow up, typically staff is in the account reviewing the registration module and ticket and has quick access to documents that will provide them with the information they need to work the claim.

Good luck!

Cristina

Posted : February 27, 2018 1:59 am

asears

(@asears)

Posts: 49

Trusted Member

Topic starter

Thank you Michelle for your response!

Posted : February 27, 2018 2:11 am

asears

(@asears)

Posts: 49

Trusted Member

Topic starter

Cristina,

This is perfect. Thank you so much for answering each concern. I will follow up with the billing manager based on these responses. This is a great help!

Thanks,
Bree

Posted : February 27, 2018 2:12 am

Crandall70

(@crandall70)

Posts: 5

Active Member

Bree,

If they have not resubmitted electronically before, let me know and I will be happy to send you a step by step document. You can reach me at [email protected].

Thanks,

Cristina

Posted : February 27, 2018 2:29 am

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