We live in a busy world where mistakes can happen. However, sometimes a seemingly small error can add up to big dollars. Luckily, Meritain Health® knows having the right partners in place can stop any potentially costly headaches for clients and members before they happen.
Recently, a behind-the-scenes collaboration between Meritain Health and Quantum Health did just that. Together, they caught a billing error before it became a larger issue—and their discovery led to almost $300,000 in total savings!
A case of mistaken identity
Patient A was involved in a serious accident and needed emergency services in her home state. Coincidentally, she shared the same name as a Meritain Health member many miles away.
After receiving treatment, patient A’s provider prepared a bill and submitted her claim. Only, in a moment of haste, the provider submitted the claim under the Meritain Health member with the same name!
The claim in question was for a high-dollar amount, prompting Quantum Health to have their Medical Management team review. Upon taking a closer look, they noticed a few things didn’t seem right. Working with a Meritain Health client advocate, they marked this claim as potentially belonging to someone else.
A little research goes a long way
Identifying this claim as having a possible mistake prevented it from being paid right away. But, more needed to be uncovered to get to the bottom of it—and determine if it did in fact belong to a non-member.
Fortunately, the dedicated Meritain Health Member Services Investigation Unit (specially trained to handle situations like this) was called in. They first saw that patient A and the member resided at different addresses, states apart from one another. This offered a clue that the claim may be a mismatch.
Working in conjunction with a research and investigation unit and the client advocate, they were able to take further steps in confirming the member’s identity. A photo ID of the Meritain Health member was obtained. After some digging, it was determined patient A and the Meritain Health member were two different people.
Accurate outcomes for the future
With the identity issues now figured out, all prior claims submitted could be voided. Additionally, Meritain Health flagged the member record so no similar errors would happen in the future.
Finally, Meritain Health notified the provider of the situation so the correct patient could be billed. Quick work and supreme attention to detail resulted in a no-hassle outcome that saved almost $300,000–taking just 24 hours from start to finish!
To learn more about Meritain Health benefit plans please contact your Meritain Health representative.
This story is based on an actual client experience. Names and information have been changed to protect the client’s privacy.
This communication is intended for informational, promotional purposes only. The amount of total savings represents the savings off out-of-network billed charges that are the product of individual negotiations directly with the provider. The reference to previous outcomes made as a part of this communication does not guarantee success or similar outcomes in any new or future negotiation, as the result of each case depends upon many factors, including but not limited to the facts of each case.
Health benefits and health insurance plans contain exclusions and limitations; see your plan documents for complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary and are subject to change.
