Multiplan Issues

cs7@appanet.comcs7@appanet.com
in Orthopedics
I have noticed more and more companies are using Multiplan for their bill review/adjustment. Multiplan is horrible! They are constantly entering and reducing claims incorrectly. I am still fighting with them for claims from 2014! Has anyone else had this issue? And, if so, what recourse was taken?

Comments

  • cwyman@uopc.orgcwyman@uopc.org
    edited May 2017
    We had a problem with them and terminated our contract. They failed to
    disclose they had a contract with another insurance carrier that stated the
    repricing would be either that insurance carriers R & C or our Multiplan
    rate whichever was less.

    The claims were always paid wrong and it the guidelines for when Multiplan
    came into play and if the out of network benefits were still to be used.

    ​


    Carla Wyman, CPC, COSC

    Revenue Cycle Manager



    University Orthopaedics, PC
    19 Bradhurst Avenue, Suite 1300N
    Hawthorne, NY 10532
    Tel - 914-789-2710
    Fax - 914-789-2744

    www.uopc.org
  • Tolorthocoder1Tolorthocoder1
    edited May 2017
    Speaking nicely, Multiplan is very problematic.... We have had issues before and our office manager has had to fight to get our services paid at the correct rate. Every so often, the issue comes up again.

    Sandi Hamrick, CPC
    Toledo Orthopaedic Surgeons 
  • cs7@appanet.comcs7@appanet.com
    Thanks guys. I had about 10 surgeries that were paid with anesthesia guidelines instead of the surgical guidelines. I have 2 that they keep claiming they forward to the insurance companies but they never get them. And just yesterday they denied one of the claims as surgery date was prior to the injury date; that they already paid incorrectly. I called them and told them they were bordering on fraud. Needless to say they "escalated" this surgery.
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