DESCRIPTION OF THE ISSUE
Provider’s TIN# was linked with the individual provider name but it should be linked with the Group name as Prime Hospitalists Group. So the claims that were filed with individual name was processed under Out of network.
CONCEPT
Provider’s TIN# should be linked to the Group of Prime Hospitalists Group.
REASON
We tested few sample claims under individual provider name and they were also processed as Out-of-network. Upon analyzes found provider’s TIN# linked to individual name instead of linkage with the Group name. On reaching Provider Relations Dept, requested us to allow 30 business days to have the correct information updated in their records. Later on the filed claims were processed under Fee-for-service reimbursements.
