The payer-provider dispute stems from a reimbursement discrepancy discovered in April. NMHS staff found UnitedHealthcare issued remittances showing the insurer paid some claims $0 rather than denying the claims as ineligible.
This can significantly impact a hospital’s financial health. A claim denial triggers an alert in the hospital’s payment system notifying staff a claim needs to be adjusted and resubmitted for reimbursement. Staff who are unaware a claim was denied are less likely to make the proper adjustments, causing the hospital to lose out on reimbursement.
UnitedHealthcare contends it paid the claims appropriately and did not breach its contract with NMHS.
“We do not believe their [network] termination notice is valid and feel strongly that the hospital system should honor its contract as we continue a thorough review of the claims they are disputing,” Daryl Richard, a UnitedHealthcare spokesperson, said in a statement.
NMHS and UnitedHealthcare’s contract expires in May 2017.
The Mississippi Insurance Department launched an investigation into the dispute Oct. 21. It has not issued a decision.
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