Wiki Specialist Copays

[jessicajoyce1]

I work for a group a specialists and we pre-collect the specialist copays. However, when getting back EOBs we are often being processed at the primary care copay, creating refunds. We have checked with our payers and we are enrolled as specialists. Is anyone else having this issue or know what would cause it?

 

[csperoni]

It happens with my practice occasionally. For me specifically, the issue is the providers are gynecologic oncologists (and credentialed as such). Some carriers will sometimes process as ob/gyn, resulting in a primary care copay applied.
Another possibility is some plans have different tiers. So a tier 1 specialist might be the same copay as a tier 2 primary care.
If it were me and I believe the insurance is making an error, I would have a simple standard form letter advising of the error. Ask for the claim to be reprocessed and for instructions to submit the refund upon corrected claim processing.
If it is mostly one particular carrier, you can try their provider relations department. Or submit a spreadsheet of multiple claims.