Call center agents need to be able to identify these cases and apply the correct scripts
What is happening?
- Horizon cases with TSE add-on were billed incorrectly, and the corrected claims were submitted in early November
- The initial claim only included the TSE (Tay Sachs Enzyme) CPT codes
- The corrected claim included the unbilled CPT codes
- Due to additional codes billed, patients may have new Patient Responsibility and owe or cases previously at zero balance
- This DID NOT impact PTP cases, it does impact insurance and self-pay cases
You will see a memo stating “HORIZON CORRECTED CLAIM – FOLLOW SCRIPT”
Use the scripts bellow and please remember the patient is responsible of paying the higher bill because that’s the correct amount. Follow your Walkdown and take payments for these cases
Why did I get another bill? I already paid this.
- We submitted a corrected claim with additional codes to reflect the Horizon panel ordered by your doctor. With the additional codes, your insurance put more towards patient responsibility, and that’s why you received another statement from us.
Why didn’t you submit the claim correctly the first time?
- Unfortunately, when we first submitted the claim, those codes were not included. During a routine audit, we found these codes were not submitted, and then we sent a corrected claim.
How can you do this?
- We can bill the codes for the service we provided, which is the Horizon Carrier Screening.
I’m not paying this.
- I understand this came as a surprise to you and I apologize. I can set-up a payment plan / offer a discount, etc. (follow Walkdown)
- I understand your financial situation has changed. I can pre-screen you for our Compassionate Care program.
Are you getting double payment for the code you did bill?
- No, we submitted as a corrected claim, so the insurance knows they already processed the Tay Sachs codes before.
What did you bill?
- First, we billed the procedure codes for TSE – Tay Sachs Enzyme, which is part of your Horizon panel. Those codes are 80500, 82657, 83080, 84155.
- On the corrected claim, we billed the additional codes. (find codes in History Tab)
Agent FAQs
- Can these patients apply for Compassionate Care?
Yes, we understand their financial situation may have changed.
- What if a courtesy exception approved amount was already paid?
The courtesy exception approval is in the notes and the patient already paid the agreed amount, then ZBAL the case
Last update by: Claudia F (August 6, 2024)