Loading ...
Sorry, an error occurred while loading the content.

RE: [MedicalBillers] Problems with Kaiser Permanente Claims

Expand Messages
  • Linda Walker
    Marta, did you check with your clearinghouse and make sure your codes are not getting trunucated? Linda Walker Practice Managers Resource & Networking
    Message 1 of 2 , May 21 12:59 PM
    • 0 Attachment
      Marta, did you check with your clearinghouse and make sure your codes are
      not getting trunucated?



      Linda Walker

      Practice Managers Resource & Networking Community
      <http://www.billerswebsite.com> http://www.billerswebsite.com
      A division of K&L Media, LLC
      <http://www.klmediallc.com> http://www.klmediallc.com

      Website Design & Management for the Medical Services Industry



      From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
      On Behalf Of Marta Sanders
      Sent: Thursday, May 21, 2009 3:49 PM
      To: MedicalBillers@yahoogroups.com
      Subject: [MedicalBillers] Problems with Kaiser Permanente Claims








      Hello,
      I'm hoping that maybe some of my fellow medical billers from the Washington
      DC area will be able to help me.

      I am having a difficult time getting Kaiser Permanente to pay their claims
      correctly. This problem only happens at the Rockville, MD Kaiser location
      and all claims that I send to Plano, TX are paid fine. Basically, Kaiser
      denies ever other claim for reasons such as "5th digit of diagnosis missing"
      which is simply not true. I include it on every claim. Some claims are
      denied due to no auth. Again, authorization number has been included on each
      claim. I am at a loss of what to do.

      I talked with them over the phone and sent complaints along with my claim
      appeals. Same problems continue happening. I'm not sure how paper claims get
      processed once they reach the insurance co., but I get the feeling that
      either my claims go to the same "sloppy" data entry person, or Kaiser is
      simply trying to hold on to their money as long as possible so that it
      generates interest for them before they pay the provider.

      At this point, I'd rather do five Medicare claims for one Kaiser claim (have
      had no problems with Medicare!). I have asked the provider to contact Kaiser
      and I'm looking into getting set up to file electronically with them, hoping
      that will make a difference. My provider has a very small mental health
      practice and so far electronic billing software has not been cost effective
      (we use web based claim filing for most of our other billing).

      Any thoughts or suggestions will be much appreciated!

      Marta





      __________ Information from ESET Smart Security, version of virus signature
      database 4094 (20090521) __________

      The message was checked by ESET Smart Security.

      http://www.eset.com



      [Non-text portions of this message have been removed]
    • JOSETTE THOMAS SYLVAN
      Some things we just have to deal with. Here in ny empire bcbs does the same thing with denials for no authorization, when in fact ther is one already on file,
      Message 2 of 2 , May 22 8:18 AM
      • 0 Attachment
        Some things we just have to deal with. Here in ny empire bcbs does the same thing with denials for no authorization, when in fact ther is one already on file, on the claim, etc. Every month, or 2 months I call to speak with a live rep ( even spv's)to only have them reversed for payment. No logical explanation except the system does not pick up on the authorization even if it is there on paper or electronic billing, Go figure! I gave up more than 5 years now.



        The fifth digit is another story altogether?



        To: MedicalBillers@yahoogroups.com
        From: martasan@...
        Date: Thu, 21 May 2009 19:49:19 +0000
        Subject: [MedicalBillers] Problems with Kaiser Permanente Claims







        Hello,
        I'm hoping that maybe some of my fellow medical billers from the Washington DC area will be able to help me.

        I am having a difficult time getting Kaiser Permanente to pay their claims correctly. This problem only happens at the Rockville, MD Kaiser location and all claims that I send to Plano, TX are paid fine. Basically, Kaiser denies ever other claim for reasons such as "5th digit of diagnosis missing" which is simply not true. I include it on every claim. Some claims are denied due to no auth. Again, authorization number has been included on each claim. I am at a loss of what to do.

        I talked with them over the phone and sent complaints along with my claim appeals. Same problems continue happening. I'm not sure how paper claims get processed once they reach the insurance co., but I get the feeling that either my claims go to the same "sloppy" data entry person, or Kaiser is simply trying to hold on to their money as long as possible so that it generates interest for them before they pay the provider.

        At this point, I'd rather do five Medicare claims for one Kaiser claim (have had no problems with Medicare!). I have asked the provider to contact Kaiser and I'm looking into getting set up to file electronically with them, hoping that will make a difference. My provider has a very small mental health practice and so far electronic billing software has not been cost effective (we use web based claim filing for most of our other billing).

        Any thoughts or suggestions will be much appreciated!

        Marta










        [Non-text portions of this message have been removed]
      Your message has been successfully submitted and would be delivered to recipients shortly.