RMK HOLDINGS INC. specializes in fulfilling the resource gap after the medical claim is billed.
BALANCE: $ 1,233.00
PROBLEM: Claim denied needing primary EOB.
SOLUTION: Claim billed to supplemental policy instead of MMAI policy which was effective for service date.
BALANCE: $ 2,176.00
PROBLEM: Claim denied because of no insurance coverage for service date.
SOLUTION: Claim was filed to incorrect claims address.
BALANCE: $ 1,013.50
PROBLEM: Claim denied because of insurance ID mismatch.
SOLUTION: Claim filed to traditional plan vs. community care.
BALANCE: $ 1,203.00
PROBLEM: Patient disputed charge/balance owed, comparing it to a similar past bill.
SOLUTION: Explained itemized charges and balance owed because of deductible. Patient stated first time someone took the time to explain and set up a payment plan.
BALANCE: $ 1,007.50
PROBLEM: Denied by hospice as non-eligible benefit and Medicare as ID name mismatch.
SOLUTION: Verified/corrected Medicare ID, name and date; confirmed hospice non-eligibility.
BALANCE: $ 1,305.00
PROBLEM: Denied no pre-authorization for service.
SOLUTION: 3-way call with patient and insurance. No ER report on file when claim originally submitted. ER report since received.
BALANCE: $ 1,001.50
PROBLEM: Denied with "misrouted" and "claim not covered by payor".
SOLUTION: 3-way call with patient and insurance. Claim was related to mental health so should have been filed through carve out policy.
BALANCE: $ 1,690.00
PROBLEM: Insurance benefits exhausted denial at clearing house level.
SOLUTION: Consumer questioned why claim repriced differently than a claim from a prior year. Investigated with insurance who confirmed a claim was not on file.
Claim resubmitted and consumer held responsible for their portion only vs. full charge according to provider-payor contract.
BALANCE: $ 4,540.50
PROBLEM: Multiple bills, same service dates as claims already paid. Denied due to no pre-authorization for service.
SOLUTION: Call to insurance who verified no pre-authorization requirement. Two claims not found. To prevent duplicate denial upon resubmission, account rep notated resubmission for return transportation trip. Proof of timely filing submitted with claims.
BALANCE: $ 1,180.00
PROBLEM: Denied due to no pre-authorization for service.
SOLUTION: 3-way call with patient and insurance. Claim should have been sent directly to IPA vs. umbrella insurance location.
BALANCE: $ 1,117.00
PROBLEM: Unpaid due to incomplete demographic information.
SOLUTION: Contacted pick up and drop off locations. Sent release to obtain information and patient’s name misspelled.
BALANCE: $ 1,605.00
PROBLEM: Denied due to medical necessity.
SOLUTION: 3-way call with patient and insurance. Spoke with multiple reps and received different answers including claim not found. Claim was found with no response from medical board. Patient had to submit medical records.
BALANCE: $ 1,007.50
PROBLEM: Denied multiple times as duplicate.
SOLUTION: Located claim number ID, amount paid and date paid. Claim had already been paid in full but not posted.
BALANCE: $ 1,650.00
PROBLEM: No insurance on file.
SOLUTION: Pick up location was state prison. Located inmate ID and could be billed to prison insurance as still within timely filing limits.
BALANCE: $ 2,295.50
PROBLEM: Denied as “forwarded to another entity for processing”.
SOLUTION: Called insurance for medical group processing information. They did not have claim on file. Resubmitted with proof of timely filing.