Re: Digest for delaware-county-providers@googlegroups.com - 4 Messages in 1 Topic
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Linda Brennan
Jul 15, 2013, 6:07:59 PM7/15/13
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It is so nice for the info. we are sharing. This is what I am doing. I am sending a fax to McGuinness tomorrow regarding the problem with Excellus and the lack of response from Provider Support and my concern about my invoices not being received by Excellus. I am then also sending them a letter stating the same and will follow all this up with a phone call on Mon. after I call Excellus again. I am documenting all this and asked Christina where we can complain and she suggested calling BEI, Provider Unit (518-473-7016) as BEI contracted this company. Whether that will make a difference, I don't know. If they had kept responding that would help but I am getting nothing back and wish I could just deal with ins. myself. So I have a mission to bombard McGuinness with this as maybe they aren't aware of many of these problems. I realize that if a claim is rejected then the escrow will come in but boy will that be a long wait as the invoice will be resubmitted over and over. Anyway, 120 days for Excellus to cover a claim, from date of service.
On Mon, Jul 15, 2013 at 5:08 PM, <delaware-cou...@googlegroups.com> wrote:
Group: http://groups.google.com/group/delaware-county-providers/topics
Linda Brennan <brenn...@gmail.com> Jul 14 06:29PM -0400
I have gotten Apr and May Medicaid but just submitted June. I can't find
my commercial ins. id. numbers for my two kids to check the EOB on each.
Funny this just came up. They better not use it as an excuse as to why
Excellus doesn't have my invoices. Finding the ID does not fit with
directions, but will dig into it harder tomorrow. Also when we fill out
the EOB if needed, when it has us put something under status - does
'billed' mean we submitted the bill to EI billing or does it mean they
submitted to the ins. company. Excellus still doesn't have any of my many
invoices from Apr on thru June even though EI billing says they submitted
it long ago. They are not getting back to me like they used to. I sent 3
Emails last week regarding the invoices and they haven't responded.
Medicaid has also turned down a child thru 3 cycles because the parents
didn't have it when I saw her, and it still hasn't gone to escrow. I won't
have any commercial ins. kids after Aug. 31, just a few Medicaid. I will
then work to get what I am owed before I take anymore. Glad you got your
check. Thank goodness for my 3-5 kids.
On Sun, Jul 14, 2013 at 5:09 PM, <delaware-cou...@googlegroups.com
Libby LePinnet <libbyl...@gmail.com> Jul 14 06:02PM -0700
I wondered the same thing.... "under status - does 'billed' mean we
submitted the bill to EI billing or does it mean they submitted to the ins.
company"
I emailed last week regarding this and other questions like I posted and
also they haven't got back to me like they used too....
On Sunday, July 14, 2013 6:29:33 PM UTC-4, brennanslp wrote:
Linda Brennan <brenn...@gmail.com> Jul 15 12:55PM -0400
FYI everyone, today, Monday again called Excellus and they still haven't
received any invoices to include Apr,May and June. I Emailed Provider
Support 3 x last week with no response but I figured they would fix it.
Excellus only allows 120 days from date of service to cover a claim. Where
can I complain about this, Provider Support is not helping at all,
totallying ingnoring me. Do we have any phone numbers for McGuinness?
Just want everyone to be aware.
Amanda Lewis <alew...@gmail.com> Jul 15 01:28PM -0400
--
The numer I was calling at mcguiness is 518-393-3635. Hope this helps. I
have excellus kids too and they do not have my claims yet either. I feel
like there is some real problems with this system and no one with authority
to fix it. I believe the understanding was that the county escrow was to
cover anything not paid or denied by insurance so I hope they will cover
denied services if they are not received in time. I feel like I was very
patient at the beginning and willing to deal with a few bumps in the road,
but this is getting ridiculous.
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souleab67
Jul 16, 2013, 6:51:20 PM7/16/13
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Hello -- here's the latest info I have received.
According to Fidelis, they sent me a check for 1/3 the billed amount per claim. I haven't received it as they said they sent it to me on July 10. The amount was for scattered dates of services and only 11 of them. By "scattered" I mean, they have said they paid x amount for April submissions and then paid out for 2 June submissions. The lady on the phone with me was very difficult to understand and she was given to me as the first person I spoke with had NO CLUE as to how to check claims. She was very short with me so I just hung up after 30 min of chaos. Ok - there is NOTHING in eibilling to indicate that insurance paid or did ANYTHING with these claims. As for a child with CDPHP, I've just received a standard "denial letter" stating an "RGR" code which means "unauthorized services by a non-par provider. Member liable." SO, I checked EIbilling site and they have NOTHING in there to indicate anything different than the fact that "all was ok" and waiting on insurance. I did email provider support 2x now with no response.
I contacted Christina and Bonnie at DCPH. This is their response (which I forwarded to eibilling)-->
On Monday, July 15, 2013 6:07:59 PM UTC-4, brennanslp wrote:
According to Fidelis, they sent me a check for 1/3 the billed amount per claim. I haven't received it as they said they sent it to me on July 10. The amount was for scattered dates of services and only 11 of them. By "scattered" I mean, they have said they paid x amount for April submissions and then paid out for 2 June submissions. The lady on the phone with me was very difficult to understand and she was given to me as the first person I spoke with had NO CLUE as to how to check claims. She was very short with me so I just hung up after 30 min of chaos. Ok - there is NOTHING in eibilling to indicate that insurance paid or did ANYTHING with these claims. As for a child with CDPHP, I've just received a standard "denial letter" stating an "RGR" code which means "unauthorized services by a non-par provider. Member liable." SO, I checked EIbilling site and they have NOTHING in there to indicate anything different than the fact that "all was ok" and waiting on insurance. I did email provider support 2x now with no response.
I contacted Christina and Bonnie at DCPH. This is their response (which I forwarded to eibilling)-->
Yay!!
Yes, with the denial you should now be paid from the county escrow account. Unfortunately I have nothing to do with that.
I would contact eibilling.com and make sure that they also received the denial information and are processing a check to you. I would also ask them about having future bills bypass the insurance process for this CDPHP child as you are not a participating provider and they are not going to pay any bills you submit. Maybe they could enter a blanket denial code for you and then for the future bills you would not need to wait for the insurance response. Not sure they can do that but it’s worth a shot! -Christina
This denial goes to the fiscal intermediary and we have money on account in escrow with them. They will write you a check. I don’t know if the fiscal intermediary gets this info automatically or if you have to let them know. Christina may have the answer to that. Bonnie Hamilton
So- no one can really claim responsibility. Amy
On Monday, July 15, 2013 6:07:59 PM UTC-4, brennanslp wrote:
It is so nice for the info. we are sharing. This is what I am doing. I am sending a fax to McGuinness tomorrow regarding the problem with Excellus and the lack of response from Provider Support and my concern about my invoices not being received by Excellus. I am then also sending them a letter stating the same and will follow all this up with a phone call on Mon. after I call Excellus again. I am documenting all this and asked Christina where we can complain and she suggested calling BEI, Provider Unit (518-473-7016) as BEI contracted this company. Whether that will make a difference, I don't know. If they had kept responding that would help but I am getting nothing back and wish I could just deal with ins. myself. So I have a mission to bombard McGuinness with this as maybe they aren't aware of many of these problems. I realize that if a claim is rejected then the escrow will come in but boy will that be a long wait as the invoice will be resubmitted over and over. Anyway, 120 days for Excellus to cover a claim, from date of service.
On Mon, Jul 15, 2013 at 5:08 PM, <delaware-cou...@googlegroups.com> wrote:
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