Wiki UMR AND SUREST

[Pkirsch1]

We are getting paid out of network with UMR and SUREST. When I call and talk to a rep, they do see we are in network, they send the claim back for reprocessing, the claim comes back being paid in network, but the next time the patient comes in, the claim is getting paid out of network again. And I have to keep calling.

Why does this keep happening?

Thank you for your help.

 

[JDockery]

I we experienced the same thing, a couple of questions. Are you billing Substance and Mental health? are you billing on UB, are you in network?
if yes it is the TOB that they are doing, we went to provider relations and that was the outcome of why they were paying an in network facility OON. Hope that helps