Billing with Correct Claim Numbers

In the first quarter of 2011, we reassigned over 1,200 bills due to providers submitting the wrong claim number (for the same injured worker) alone. Here are some of the reasons why we reassign bills:

• The bill was submitted under the wrong claim for the same injured worker (this group has the highest number).
• The bill was submitted without a claim number (read more below).
• The bill was submitted under the wrong claim for a different injured worker.
• The bill was submitted when more than one claim was filed and before Pinnacol designated a claim to proceed.

In addition, we reject a significant number of bills submitted electronically where a claim number is not provided. In the first quarter of 2011, this number was more than 1,100 bills — and there’s a cost associated with each bill that is rejected. The bigger problem is where some of the bills submitted electronically without a claim number get assigned to the incorrect claim. This raises concerns for our policyholders — rightfully so, as these mistakes create confusion and re-work. To find out if you’re billing Pinnacol with the correct claim number, here are some resources to help you answer this question:

• If you bill Pinnacol electronically, access the EDI bill reject report on the SelectNet website. You can view the number of bills rejected (by week for up to six weeks) along with the specific reason they were rejected.
• Contact your provider relations specialist.
• Contact Kim Do, MedPay services director, at 303.361.4821.