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NHOS
#1 Posted : Friday, May 7, 2021 7:46:02 AM(UTC)
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NHOS

Rank: New Member

Joined: 4/22/2021(UTC)
Posts: 1

Hi everyone!

I work at an oral surgeons office and we recently began submitting to medical insurance (rather than only to dental), as a few policies require medical coordination. I am finding that some Blue Cross plans (Anthem in particular) are paying an extremely low amount via MultiPlan - this is not a denial or an explanation of benefits, so I can't submit this to the patient's dental carrier. Does anyone have any suggestions or ideas on how to proceed? We are not in-network with any Blue Cross plans, so reaching a representative for help has been difficult. Thank for any advice!
courtneydsnow
#2 Posted : Thursday, May 13, 2021 11:18:54 AM(UTC)
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courtneydsnow

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Joined: 11/21/2012(UTC)
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Hi NHOS!

Question for you: are you receiving "expedited agreements" from multiplan and accepting them?
Reason i ask - if you are accepting the expedited agreements, you don't have to!

You can decline the expedited agreement (where they try to get you to agree to a lower allowed amount for your services to get the claim processed "quicker"). If you decline, the claim will process through like normal.
You can also choose to negotiate if you do want to accept it, but the allowed amount they are offering is too low.

If it is a case where no expedited/negotiated agreement was accepted and you are billing as out-of-network provider, you can send an appeal requesting a reconsideration for a higher allowed amount once the claim processes.

Hope this is helpful!
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