Case study: Insurer holding payments over tax ID confusion

June 21, 2021

The following is a column from Mick Raich, President of RCM Consulting for Vachette/Lighthouse Lab Services.

Enough already!

It has recently come to our attention that a large national health plan is denying payment for a pathology group due to confusion over their tax ID number. According to the payer, payments for the group cannot be processed because the payer believes the group of pathologists are listed under another ID number.  (Yes, you read that correctly). 

Here’s the kicker: The payer will not even tell the group what tax ID number it has them listed under! Instead, the pathologists are being asked to submit every single tax ID number they have ever worked under in hopes the payer can delist them from their old group and add them to their current group. In the interim, the payer is not even reimbursing them at an out-of-network rate! They are paying zero, nada, nothing.

To add insult to nonpayment injury, the payer is also making them wait a YEAR until they can load their new contract, if they ever get one into the system at all. Simply put, this is unacceptable. Fortunately, the group has Vachette in its corner to serve as its advocate in this fight while also untangling the mess. More to come…

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