DESCRIPTION OF THE ISSUE
Provider’s TIN# was
linked with the individual provider name but it should be linked with the Group
name as Prime Hospitalists Group. So the claims that were filed with
individual name was processed under Out of network.
CONCEPT
Provider’s TIN# should
be linked to the Group of Prime Hospitalists Group.
REASON
We tested few sample claims under individual
provider name and they were also processed as Out-of-network. Upon
analyzes found provider’s TIN# linked to individual name instead of linkage
with the Group name. On reaching Provider Relations Dept, requested us to
allow 30 business days to have the correct information updated in their
records. Later on the filed claims were processed under Fee-for-service
reimbursements.
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