Payers – Can’t Live with ‘em and Can’t Live without ‘em

Our payers are obviously a huge part of our lives. When things are going smoothly, life is good but let one little edit get out of kilter and claims are rejected and delayed.  Claims can be paid today and then BAM all of a sudden your provider’s claims process as non-par. How could that happen? Through absolutely no fault of your own an error occurs on the payer’s part and claims are all processed incorrectly. After 45 minutes on the phone you convince the clerk that your provider is in network and you are told they will reprocess the claim, you should have payment within 30-45 more days. After a long wait you receive additional payment but of course, some are denied as duplicate, so more time is spent getting your claim paid correctly, again, through no fault of your own.  Once a claim is paid incorrectly it can turn into a nightmare to actually get the money due your provider. The key is to continue to pursue it because the provider is due the money. Once this snafoo is cleared up, you can sit back, process your claims and wait on the next one to come along. Because, it saddens me to say, that it will……

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