TJAlexander
Guest
- Messages
- 81
- Best answers
- 0
Hey all -
Our Urgent Care clinic has specific contracts in place for each payer that vary in claim submission methods. Some payers require the use of the 'S' global urgent care code, others only require the use of the E/M code while others are FFS. I'm having a problem getting paid by secondary payers whose contract submission differs from the primary payer even when the COB has been received.
What is the rule regarding secondary payers? Are they required to honor the primary EOB or can they deny the claim saying its out of contract? My dilemma is that if I create a corrected claim to honor the secondary contract, it will not match the COB and will STILL be denied. Can I bill the patient in these cases?
Thanks!
Our Urgent Care clinic has specific contracts in place for each payer that vary in claim submission methods. Some payers require the use of the 'S' global urgent care code, others only require the use of the E/M code while others are FFS. I'm having a problem getting paid by secondary payers whose contract submission differs from the primary payer even when the COB has been received.
What is the rule regarding secondary payers? Are they required to honor the primary EOB or can they deny the claim saying its out of contract? My dilemma is that if I create a corrected claim to honor the secondary contract, it will not match the COB and will STILL be denied. Can I bill the patient in these cases?
Thanks!