Midlands Choice often receives claims with group and payer information that is no longer accurate or for groups that no longer have a relationship with Midlands Choice. Entering current group data not only prevents a HIPAA violation, but can also improve claim payment turnaround time.
When Midlands Choice receives a claim, it is repriced based on contracted rates and then forwarded along with the pricing to the insurance company or third party administrator for adjudication and payment consideration. Since Midlands Choice works with over 70 payers, unless the correct group information from the patient’s member identification card is populated on the claim, there is no way to determine where the claim should be sent. Remember to ask for a copy of the patient’s most current member identification card prior to providing care or services.