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Wiki PROVIDER OUT OF NETWORK

Pkirsch1

Networker
Messages
96
Location
Bristol, CT
Best answers
0
One of our providers is out of network and Anthem is paying the subscriber. The member does not want to cash the check. Wants to wait for the provider to be credentialed (which we are working on). Does she have to cash the check?
 
Unless Anthem is going to back date the effective date of the provider's contract to cover the dates of service that the patient has received checks for, then yes, the patient needs to cash the checks and if she hasn't already paid your office pay you what she owes.

If Anthem is going to back the effective date to cover all of her visits or to some degree that would cover some of her visits, then it is likely easier for her to not cash the checks. I work for an insurance company and it easier for us if the patient hasn't cashed the check because we can put a stop pay on the check and then reprocess the claim to issue the payment to the provider.
 
Yes the patient needs to cash the check because that is part of her out of network agreement with her insurance. The insurance is paying for the services that were provided by your provider at a out of network reimbursement rate, unfortunately they send the payment to the patient instead of the provider. Even if you're trying to get credentialed with the insurance, that credentialing effective date may be past the date of service and she will still need to sign the reimbursement check.
 
Unless Anthem is going to back date the effective date of the provider's contract to cover the dates of service that the patient has received checks for, then yes, the patient needs to cash the checks and if she hasn't already paid your office pay you what she owes.

If Anthem is going to back the effective date to cover all of her visits or to some degree that would cover some of her visits, then it is likely easier for her to not cash the checks. I work for an insurance company and it easier for us if the patient hasn't cashed the check because we can put a stop pay on the check and then reprocess the claim to issue the payment to the provider.
Thank you so much for your help!
 
Unless Anthem is going to back date the effective date of the provider's contract to cover the dates of service that the patient has received checks for, then yes, the patient needs to cash the checks and if she hasn't already paid your office pay you what she owes.

If Anthem is going to back the effective date to cover all of her visits or to some degree that would cover some of her visits, then it is likely easier for her to not cash the checks. I work for an insurance company and it easier for us if the patient hasn't cashed the check because we can put a stop pay on the check and then reprocess the claim to issue the payment to the provider.
Thank you so much for help!
Unless Anthem is going to back date the effective date of the provider's contract to cover the dates of service that the patient has received checks for, then yes, the patient needs to cash the checks and if she hasn't already paid your office pay you what she owes.

If Anthem is going to back the effective date to cover all of her visits or to some degree that would cover some of her visits, then it is likely easier for her to not cash the checks. I work for an insurance company and it easier for us if the patient hasn't cashed the check because we can put a stop pay on the check and then reprocess the claim to issue the payment to the provider.
Unless Anthem is going to back date the effective date of the provider's contract to cover the dates of service that the patient has received checks for, then yes, the patient needs to cash the checks and if she hasn't already paid your office pay you what she owes.

If Anthem is going to back the effective date to cover all of her visits or to some degree that would cover some of her visits, then it is likely easier for her to not cash the checks. I work for an insurance company and it easier for us if the patient hasn't cashed the check because we can put a stop pay on the check and then reprocess the claim to issue the payment to the provider.

Yes the patient needs to cash the check because that is part of her out of network agreement with her insurance. The insurance is paying for the services that were provided by your provider at a out of network reimbursement rate, unfortunately they send the payment to the patient instead of the provider. Even if you're trying to get credentialed with the insurance, that credentialing effective date may be past the date of service and she will still need to sign the reimbursement check.
Yes the patient needs to cash the check because that is part of her out of network agreement with her insurance. The insurance is paying for the services that were provided by your provider at a out of network reimbursement rate, unfortunately they send the payment to the patient instead of the provider. Even if you're trying to get credentialed with the insurance, that credentialing effective date may be past the date of service and she will still need to sign the reimbursement check.
Yes the patient needs to cash the check because that is part of her out of network agreement with her insurance. The insurance is paying for the services that were provided by your provider at a out of network reimbursement rate, unfortunately they send the payment to the patient instead of the provider. Even if you're trying to get credentialed with the insurance, that credentialing effective date may be past the date of service and she will still need to sign the reimbursement check.
Thank you!
 
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