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Filing

Marilyn Posted Tue 05th of February, 2019 22:25:21 PM
My question is that, when there is a primary and secondary insurance, then two years later, the order of the insurance is reversed due to court order. Now the insurance that became secondary is recouping what was paid during the time period, and so the claims are resubmitted to the insurance that was secondary but became primary, but now the issue is that the insurance is rejecting the claims are "timely filing" no matter the issue is or was. Would that be correct since there is a court order. The insurance said that they are following STD guidelines, doesn't matter is there is a court order.
SuperCoder Answered Wed 06th of February, 2019 07:44:31 AM

Hi Marilyn,

 
In such a case, the primary insurance which is now secondary, may recoup the payment for the claims from the effective date of the order not before that. And those claims should be submitted to the secondary insurance which is now primary. If now primary insurance is denying claims, please send them the copy of the court’s order with the effective date and a letter requesting the payment. Please let us know if there is any issue regarding the payment.
 

Please feel free to write if you have any question.

 

Thanks

Marilyn Posted Wed 06th of February, 2019 09:12:29 AM
Both insurance have the court order. The problem is that the secondary who is now the primary will not pay but to say untimely filing when rerouting some claims to them. We are being told that court order or not, they stand their ground of their STD timely filing policy which is one year for this policy. How would we have known this would happen?Yes, the primary which is now secondary has recouped money paid during the effective dates and have rerouted the recouped claims to the secondary which is now primary, but as I mentioned, claims are getting denied as untimely filing.
SuperCoder Answered Thu 07th of February, 2019 07:51:28 AM

 

Please go for an appeal and attach a copy of court’s orders along with the appeal. The claims should have been submitted as per the change in primary and secondary insurances as per the court’s order. Moreover, payers should also have worked accordingly immediately from the effective date.

 

But in any case, if a mistake has happened at any end, now the payers should cooperate and make appropriate payments. Please write a letter to insurance explaining the reason of not filing the claims in time. Hope it may work.

 

Thanks

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