Recent Posts

Saturday, April 2, 2011

FILING OF CLAIMS WITH INCORRECT PROVIDER TIN#

DESCRIPTION OF THE ISSUE

Most of the claims under Optimum healthcare were in outstanding for correct TIN# information.  Upon verification we found Dr. to be capitated under IPA which included both Optimum and Freedom healthcare plans as PCP with another TIN#.  Hence the claims were unpaid for submission of correct TIN#

CONCEPT
Dr.  being a specialist had dual TIN#, one for PCP and the other for Specialty.  IPA have enrollment record of Dr.  as a Specialist.  So upon filing of claims with PCP TIN# got denied for request of correct TIN#.

SOLUTION
On identification of this issue, we started resubmitting the unpaid claims with appropriate TIN# on records of IPA for Dr..  This in return reflected with the Capitated payments for the provider.

No comments:

Post a Comment

Popular Posts