(Commercial Payor Relations Committee continued) requires Prior authorization.” It would be very helpful if payors provided all of the reasons for denying a claim. For example, instead of denying a claim as “Benefits exhausted,” tell me “Benefits exhausted for Outpatient services as of XX/XX/XX.” If a claim is denied for terminated coverage, it would be most helpful if the date was indicated. similarly, if I send a claim to an insurance company for a behavioral health claim but the management of such claims has been subcontracted out to a third-party administrator (TPa), then it would be ideal if the payor were to give me a code identifying the TPa. Communication is Key For electronic remittances, all payors must use standardized code sets. many of these reason and remark code sets are poorly worded and could be improved for the benefit of everyone in the healthcare industry. OK, time to get off my soapbox! my goal is to proactively work alongside payors so we can influence positive changes and improve communication. However, this may take some time. The key here is that it is mutually beneficial for payors, billing companies, and providers to communicate more clearly. We must do this since we are in this industry together. Our bottom lines are being squeezed, and improved efficiency is a must. as a member of the CPr Committee, I learned that the payors are willing to be part of the solution! This committee is a great benefit to our HBma members, since we can be proactive in making changes with the payors. The CPR Committee Needs Your Help! The payors are willing to help, but we need to give them examples. I provided some of my general “pet peeve” denials. However, we need to provide the payors with actual claims data that they can review internally and analyze. Too often payors simply do not understand how providers and billing companies address certain denials or, for those denials that are unclear, cause us to make additional inquiries. If they understand our perspective, we can all win. HBma has such a tool for your use. as an HBma member company, you can log onto the website and use the “Payor reporting Tool.” This link can be found under the middle section of the website, under “Programs & Tools.” Pick the radio dial marked “Commercial,” and take some time to complete the information. I know we are all busy, but it is only through excellent communication with the payors that we can all effect positive change. Please help the CPr Committee help you! 10 HBma BIllINg • maY. juNe.2014 Newly Minted Members David Terrio BTQ Financial, New York, NY Brian Wellock Escallate, LLC., North Canton, Ohio Thomas Mathews OnQ Operating Company, LLC, Houston, Texas Asher gancz Medical Data Consultants Inc., Brooklyn, New York Kristeen Coronado Enhanced Revenue Solutions, LLC, Houston, Texas Adrian Baudoin Acadiana Computer Systems, Inc., Lafayette, Louisiana Louise Macy Advantage Billing Service Inc., Owings Mills, Maryland Pam Janney Foremost Medical Billing, LLC, Monkton, Maryland Renee Hoff TRE Medical Solutions, Inc., St. Louis, Missouri Nicolas gil Cloud Medical Solutions, Miami, Florida David Monaghan BOSS Medical Professionals, LLC, Tooele, Utah Jeanette Weiler Physicians Lifeline, LLC, Rio Rancho, New Mexico Valerie Larson-Lohr TCB Physician Billing Solutions, San Antonio, Texas Beverly Ellis x2medicalbilling & EDI, Farmersville, Texas Luis Bernal Scout Revenue LLC, San Diego, California Charity M New England Practice Management, West Springfield, Massachusetts Durie Andrews Renaissance Physician Services, Chattanooga, Tennessee Regena Virgil Resource Billing & Consulting, Visalia, California Linda Thomas Ambulance Billing Co., LLC, Pittstown, New Jersey Lydia Bailey Integrated Health Management, LLC, Killeen, Texas Shwetabh Kumar Pacific Global, Inc., Wilmington, Delaware
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