Worst Claim Story- March 2018

By Connie Loomis

I had just started an office that had Texas Medicaid. I filed several claims on the portal. and for some reason two claims processed with the office TPI number instead of the rendering provider TPI.

I re-filed the claims on the portal. They were past the 95 day timely filing so were denied.

I then called Texas Medicaid and I spoke to someone in the appeals department and she stated that I needed to print off the EOB’s and just cross out the incorrect TPI and write in the correct TPI.

This had to be mailed in.

I did this. I called a month later and they informed me they  did not receive it and asked me to send it in again.

I printed it off again and corrected the TPI. I mailed it and called  30 days later and was told again there was no appeal on file.

I was informed that I should send it registered mail so they can trace it.

I printed it and corrected the TPI again and sent it registered mail. I called 30 days later. It was not on file. I told them that I sent it certified mail so they were able to find it with that.

I was informed that I did not circle the claim number that needed to be reviewed. I informed him that both claims on the EOB were for the same patient and same DOS. He insisted that they could do nothing since the claim number was not circled. I asked to speak to a supervisor. I informed him of the same information. He also told me there was nothing they could do. I had to send it in with the claim number circled. He informed me I did not have to send it in certified mail. I told him that I think I did have to with the history that I was having trying to get these paid.

I printed off the EOB’s. I circled the claim number, crossed out the incorrect TPI and wrote in the correct TPI. I sent this certified mail.

I called 30 days later and was informed that they could not process the appeal. I could only have one claim per sheet of paper. Since there was 2 claim numbers on the EOB they could not process it. I informed then that I was told all I had to do was circle the claim that I wanted reviewed. I was told that was incorrect. The EOB can only have the claim that you want reprocessed on the EOB.

I printed off the EOB showing only the one claim that denied for incorrect TPI. I corrected the TPI and sent it with an appeal letter stating all the problems and attempts I had trying to get this paid. I listed all the certified letter numbers so they could pull them up.

Two weeks later I had two paid claims.

eAssist Helpful News and Billing Tips; Edition #121


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