Wiki Anesthesia Claim Denial

[tolbert4]

Ambetter is denying our anesthesia claim stating they do not have the facility claim. They also denied the surgeon's claim. After they received the facility claim finally they then denied our claim for timely filing? They are stating they are allowed to do this. I am trying to find a policy that states otherwise, because I feel they are being fraudulent.

 

[jkyles]

Hi there, I would start by checking your contract. It should include information on timely filing deadlines.

 

[tolbert4]

Well the thing is we are not contracted with this payer.

Hi there, I would start by checking your contract. It should include information on timely filing deadlines.

We are not contracted with them at all. Our claim reached the facility within the correct time frame, but they denied it because they did not have the facility claim, and once they finally received it, they denied ours for being timely.