Return of the Platinum Service

    Last Friday we sent the below notice.  There will be two minor changes from the below notice.  

• First, we will automatically follow up on any claims that are denied in error OR which remain open after 30 days.
• Second, there will NOT be a fee if we follow up on a claim where the payer had paid you and your office had failed to provide us a copy of the EOB.

HOWEVER, we will be enforcing the below rule that was in effect previously:

• Providers must provide copies of all EOBs to us AT LEAST once a week.  Ideally every day providers should upload scanned copies of EOBs to the Support Suite.  For practices that do not submit copies of EOBs AT LEAST once a week, follow-up of claims will be suspended.

The reason for the above rule is simple.  Providers want us to focus on following up on claims that require follow-up attention and not on claims that have already been properly processed.

Again, see below for the notice sent last Friday and just remember the minor changes (indicated above):

You spoke, we listened.  We have heard from a number of former Platinum Service providers who have requested that we reinstate the Platinum Service.  The primary reason for this request is certainty of fees.  By paying one low fee that includes insurance verification and follow up, providers are better able to esimtate their monthly fees.

     With that in mind, we are effective immediately reinstating the Platinum Service.  As a reminder the Platinum Service includes:

• Claim Submission
• Posting of all payments
• Insurance Verification for new patients and for patients who change insurance
• Follow-up of oustanding/denied claims
• Authorization and Benefit Tracking.

FEES:

     The fees will be the same as before:

• $3.99 per claim ($199.95 per month minimum fee)
• 1000 claim prepayment for only $3.65 per claim

     THERE WILL BE ONE IMPORTANT CHANGE, HOWEVER.  Because 80% of the claims we previously followed up on were paid to the providers but the providers had failed to provide us copies of EOBs, we will now provide 2 options for providers:

• Automatic Follow-Up of Claims (we will automatically follow up upon any claims denied in error or open after 30 days)
• Your office advises which claims to follow up upon (we will advise when claims deny in error AND we will provide an aging report showing claims open at least 30 days old)
• In addition, for payers that do not offer Electronic Remittance Advice, if you provide us a login and password to the payer's website on a weekly basis we will log into the payer's website to download any EOBs.
• THEN if we do follow up upon a claim and it is determined that the claim was processed to you on an EOB but your office failed to provide us that EOB, a follow-up fee of $7.95 per claim shall be assessed.  Again, this fee will only be charged in the rare times when we follow up on a claim and it is determined that you had already received the EOB from the payer but failed to provide it to us.
• HOWEVER it is strongly recommended that every day providers scan EOBs they receive that are not in the RPA portal and provide them to us.  If your office makes this part of the daily routine you should rarely encounter the instance of when a claim has been paid, we have followed up and it was determined you had already received the EOB.  
• IN ADDITION, the follow-up service will only be available for providers enrolled under the Platinum Service.  Follow-up will no longer be available as an a la carte option for PremiumPlus providers.

HOW TO SWITCH TO THE NEW PLATINUM SERVICE

• To switch to the new Platinum Service simply send us an email requesting the change which will take place the day you send the email.  The new service will only apply to claims submitted on and after the date of your switch to the new Platinum Service.
• In addition, you must advise if you want the Automatic Follow-Up option OR if you will advise on a claim by claim basis which claims we should follow up upon.
• For our former Platinum Service providers, you will NOT automatically be converted back to the Platinum Service.  You must re-enroll for the Platinum Service.
• For those providers who are under a PremiumPlus prepayment option, ask for the fee difference for you to convert to the Platinum Service.

 IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO ASK.

Thanks,

Steve