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Lori Posted Mon 18th of September, 2017 18:13:44 PM
Would you please educate me as to what the requirements are for payers to pay our claims on-time? We work with an IPA group and Medi-Cal Plan who both pay our claims outside of the time frame they are supposed to. What are the laws surrounding them doing what they are supposed to do?
SuperCoder Answered Tue 19th of September, 2017 07:47:20 AM

Greetings from SuperCoder.com!

 

Different insurance companies have different reimbursement policies. Payment is made generally between 30 to 45 days. You should ask your insurance for the same.

 

Please feel free to write if you have any questions.

 

Thanks.

Lori Posted Tue 19th of September, 2017 13:25:19 PM
That did not address my question. I am aware that different payers have different days in which they are allowed to render payment (30-45). My question is...if they do not follow their own guidelines, who can we turn to? Who oversees the payers and makes them follow the rules? Is there an "insurance police department" (if you will) that keeps them in line when they do not do what they are supposed to do?
SuperCoder Answered Wed 20th of September, 2017 04:28:32 AM

The following resources that may help you in this case:

  1. Experienced health care lawyers can analyze your issues and provide a legal evaluation and risk analysis of the proposed venture, relationship, or arrangement.
  2. The Bar Association in your State may have a directory of attorneys in your area who practice in the health care field.
  3. Your State or local medical society may be a good resource for issues affecting physicians and may have listings of health care lawyers in your area.
  4. Insurance companies are regulated by their individual states. If your insurance company is not following rules under the Accountable Care Act, you can contact your state’s department of insurance to file a complaint.

For more information, please visit following link: https://oig.hhs.gov/compliance/physician-education/06help.asp

 

Thanks.

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