Wiki Billing inpatient services under professional tax ID

[mamon]

Our clinic's doctors also do hospital and facility visits. We always bill their claims under the group's tax ID. We recently had an insurance company deny our claim since they said that the member's prefix specifies that it only covers hospital services and our tax is professional, not facility.

We've always billed this way for our doctors' hospital claims and this is the first case we've had an issue due to our tax ID. I am going to appeal this but do you have any ideas on how to handle this so we would know going forward on whether we have to make changes in how we bill out this kind of claim?

Thank you so much!

 

[thomas7331]

It sounds to me as though this member's plan benefits only cover hospital charges and not physician charges and probably has nothing to do with the way you billed your claim. I'm guessing from reference to a prefix that this is a BCBS plan. If so, there are some BCBS plans where the member is covered by one insurance plan for the physician claims and a different one for the hospital claims. You'll probably need to contact the member and find out the correct insurance information to find where to bill your physician claims, and if they do not have coverage for physician services then you will have to bill them directly. I don't think an appeal will do you any good in this situation.