I work for a small payer and currently track all individual providers who submit claims making sure to load any new provider with their NPI.
My counterpart does not. They load claims to the radiology group, emergency physicians group or ancillary type groups (like physical therapy).
This means that they do much less work than we do. However, they would be unable to pull any data for a specific provider from the claims system in one of these groups.
My question is I think this is incorrect but if not I could save some significant dollars by doing the same thing.
We pay on Medicare Advantage claims and must follow Medicare Regs. If anyone knows of any documentation either way I would appreciate it.
Thanks in advance for your response.
Tammy
My counterpart does not. They load claims to the radiology group, emergency physicians group or ancillary type groups (like physical therapy).
This means that they do much less work than we do. However, they would be unable to pull any data for a specific provider from the claims system in one of these groups.
My question is I think this is incorrect but if not I could save some significant dollars by doing the same thing.
We pay on Medicare Advantage claims and must follow Medicare Regs. If anyone knows of any documentation either way I would appreciate it.
Thanks in advance for your response.
Tammy