Wiki Insurance company paid facility but denied professional claim

[michelleaapc2012]

Has anyone ever had this happen? Insurance company ABC paid the facility for a procedure, but denied professional claim. Several calls have been made to ABC and representatives state the provider office needs to contact the facility for payment. (? What? Really, since when???) ABC says an appeal can be filed if we disagree. An appeal has been filed and the denial was upheld. ABC states claim was paid correctly to the facility. What can I do, this is ridiculous.

 

[Jessim929]

Call the facility's billing department and find out if the facility billed global. If they did, they need to send a corrected claim for just the professional component. If they billed globally and refuse to send a corrected claim, then they should have to pay out the professional fee.