Insurance Hassle Reporting

 

One of the most utilized services offered by the GLMS Physician Education and Practice Support Department is Hassle Reporting, where providers can report on-going insurance issues to GLMS and we work with the payers daily and track these issues to identify trends. On average, hassle reports that are resolved have resulted in a savings of approximately $2,600 for each physician case.

Since 1998, GLMS has fostered and developed relationships with the Insurance Payers to ensure member hassles are addressed expediently. The Hassle Report Form, originally named the Hassle Factor Log, is a steady and growing part of the Society's functions and is a member benefit that provides a substantial ROI for our members. The communication channels and relationships made between the GLMS PEPS department and the representatives at each insurance company throughout the years are critical to GLMS’ success in assisting with insurance related issues.

Physician practices submit specific or general insurance hassles to GLMS after first going through the appropriate channels to resolve the concern directly with the payer. Submitted hassles are recorded in a secure database and addressed directly with carrier representatives on a regular basis.  

 

 

Over the years, reported hassles have involved inappropriate bundling of services, nonpayment for certain medications/vaccines or procedures, unreasonable pre-certification procedures, long hold times, incorrectly denied claims, policy issues, improper payer notifications and lack of payer response or follow-up.  Frequently, these complaints are not isolated, but are found to be a common trend experienced by multiple physician practices regarding the same carrier.  For this reason, it is imperative that practices notify GLMS of existing problems so that they may be resolved with the insurance carrier.  The execution of the solutions to these problems is followed up by the GLMS staff on a daily basis.

* The GLMS Hassle Reporting service is available to GLMS member physicians and their practice staff and will help us determine how we can best support practices in addressing private payer and practice management issues of concern.


What Hassle Issues are Trending in 2018?

Below is a list of hassle topics that have been reported so far in 2018. These are issues that have been addressed with payers and some of are still in process.  If you are experiencing these or other hassles with getting paid correctly, let us know. * Many of these issues have been reported by multiple practices but  are only listed once on this list. 

2018 GLMS HASSLE REPORTS by topic

 

Payer Topic
All Commercial Payers Contracting/Network issues
ALL Medicaid MCOs No Shows
CareSource Exchange Denial "No precertification"
Humana CPT 87070 / 93655 / 87651 / 87502 / 86308 / 96110
Humana CPT 99408 denials
Humana Military Tricare Provider Enrollment
Medicaid Aetna Better Health Denial "No Prior Authorization"
Medicaid Aetna Better Health/ Coventry Bilateral procedures
Medicaid Aetna Better Health/ Coventry CPT 77052-26 denial
Medicaid Aetna Better Health/ Coventry Recoupments
Medicaid Anthem Bilateral procedures
Medicaid Anthem CPT 59514-80 denials
Medicaid Anthem CPT 90460 / 99174 / 99408 / 99214 bundling
Medicaid Anthem Denial "not covered for provider specialty"
Medicaid CareSource Bilateral procedures
Medicaid DMS CPT 67900 fee sched
Medicaid DMS Inmate claims
Medicaid DMS Kentucky HEALTH
Medicaid DMS Medicare Crossovers
Medicaid DMS Provider Enrollment
Medicaid Passport Bilateral Procedures
Medicaid Passport CPT 66984/ 66982 "known issue"
Medicaid Passport CPT 67028
Medicaid Passport CPT 69436-50
Medicaid Passport CPT 76937 denials
Medicaid Passport CPT 99408 / 99174 / 94640 / 92567 Bundling
Medicaid Passport Denial "No Assigned Fee"
Medicaid Passport Denial "No Prior Authorization"
Medicaid Passport Denial "NOC Quanitity"
Medicaid Passport ERA issues
Medicaid Passport Global period denials
Medicaid Passport Incorrect ORP Recoupment Letter
Medicaid Passport Mammogram denials
Medicaid Passport Medicare Crossovers
Medicaid Passport Modifier 76
Medicaid Passport Referrals
Medicaid WellCare Bilateral procedures
Medicaid WellCare Denial "No Prior Authorization"
Medicaid WellCare Denial "questionable service" 
Medicaid WellCare Denial code 701
Passport MCR Advantage Passport Advantage System change

More Information:

GLMS Hassle Report Case Study by Dr. Trudi Rash