On behalf of Physican who provided in network care for HealthFirst patients for the past 15 years. Health First requested all medical charts to be submitted to General Dynamics. General Dynamics is a company that HF contracted for claims review.
Starting July, 2017 we have been submitting records for each and every claim. These claims were supposed to be reviewed by General DYnamics. General DYnamics did not even bother returning our phone calls for three months. Eventually after multiple calls and emails we were able to receive spreadsheets with the reasons for denials for about 70 of our claims. HUndreds and hundreds of medical records were submitted but General DYnamics took five months to give us denials for only 70 claims. Each and every denial was unsubstantiated and bogus. We were told to appeal to General Dynamics and if they deny again then appeal to HF.
we never received any response from General Dynamics or HF. They kept on saying " denied for insufficinet documentation or missing pages." We printed and resubmitted the charts to HF five times and attached spreadsheets with tracking info. When i demanded to be given more specific reason for denying all of our claims i was told by HF that they do not need to explain to me why they are denying. They have right to deny and not pay and terminate without a cause as per provider agreement.
To summarize- Health First request medical records, gave us bogus denial reasons without a chance to appeal or discuss with medical director. They also claimed we did not submit records while we submitted records multiole times with tracking numbers that indicated that they were in fact delivered. HF kept on scheduling and canceling conference calls and not giving us opportunity to appeal or question any of their decisions. Not once we were able to speak with medical director. Multiple appeals, letters, requests were sent to legal offices and corporate offices but no one is interested in addressing this situation. Meanwhile HF owes us about $300,000 which they reported as paid to NYS and got reimbursment from State. However, they do not report the fact that the claims were not paid. In addition they are paying large sums of money to out of network providers whille not paying in network providers because provider agreement does not grant the provider any rights. It is much harder to fight out of netwrok proivders where HF actually has to follow certain rules and regulations. We are filing compaints with DOH and considerering whistleblower lawsuit against Health First under NYS False Claims Act.
We were comissioned by HealthFirst to transport their patient to and from their medidal appointments, mostly dyalysis patients on a daily basia, on or about March 2016, they came back to us asking for information that we could not supply, this went on until November, when they finally listened, they asked us for deatiled information about jobs ranging from March to November, we did that, they came back and said it was not good enough. They latere came back and asked for a Driver's Attestataion, something we have never heard, all of our work/billing was done electronically. What we gathered from their request is that they issued jobs for Medicaid and Medicare without their approval and was not paid and now they want us to payback. The reason for this belief, is the information that they asked for:
1. History and Physical, presenting symptoms and complaints, findings on examination
2. Lab test results, x-rays, consultation reports (including referrals and documentation of response back to requesting physician)
3. Daily progreass notes or reports ad records of any medications prescribed relative to the treatment
The above request can only be obtained by a Health Care Professional and not a Livery Car Service, this is soemthing that woudl come from Medicare/Medicade going to the insurance company. In accordance with the Hipaa Rules and Regulations, we as a car service, this would be illegal for us to have such information.
At one point, Health first reported all the money that was billed to the IRS advising them, that is what they paid us, someone at the car service jumped the gun and advised HealthFirst of this, they supposidly sent a retraction.
We have sent a letter to all the Corporate officers and so far no replies.
Healthfirst Reviews
On behalf of Physican who provided in network care for HealthFirst patients for the past 15 years. Health First requested all medical charts to be submitted to General Dynamics. General Dynamics is a company that HF contracted for claims review.
Starting July, 2017 we have been submitting records for each and every claim. These claims were supposed to be reviewed by General DYnamics. General DYnamics did not even bother returning our phone calls for three months. Eventually after multiple calls and emails we were able to receive spreadsheets with the reasons for denials for about 70 of our claims. HUndreds and hundreds of medical records were submitted but General DYnamics took five months to give us denials for only 70 claims. Each and every denial was unsubstantiated and bogus. We were told to appeal to General Dynamics and if they deny again then appeal to HF.
we never received any response from General Dynamics or HF. They kept on saying " denied for insufficinet documentation or missing pages." We printed and resubmitted the charts to HF five times and attached spreadsheets with tracking info. When i demanded to be given more specific reason for denying all of our claims i was told by HF that they do not need to explain to me why they are denying. They have right to deny and not pay and terminate without a cause as per provider agreement.
To summarize- Health First request medical records, gave us bogus denial reasons without a chance to appeal or discuss with medical director. They also claimed we did not submit records while we submitted records multiole times with tracking numbers that indicated that they were in fact delivered. HF kept on scheduling and canceling conference calls and not giving us opportunity to appeal or question any of their decisions. Not once we were able to speak with medical director. Multiple appeals, letters, requests were sent to legal offices and corporate offices but no one is interested in addressing this situation. Meanwhile HF owes us about $300,000 which they reported as paid to NYS and got reimbursment from State. However, they do not report the fact that the claims were not paid. In addition they are paying large sums of money to out of network providers whille not paying in network providers because provider agreement does not grant the provider any rights. It is much harder to fight out of netwrok proivders where HF actually has to follow certain rules and regulations. We are filing compaints with DOH and considerering whistleblower lawsuit against Health First under NYS False Claims Act.
We were comissioned by HealthFirst to transport their patient to and from their medidal appointments, mostly dyalysis patients on a daily basia, on or about March 2016, they came back to us asking for information that we could not supply, this went on until November, when they finally listened, they asked us for deatiled information about jobs ranging from March to November, we did that, they came back and said it was not good enough. They latere came back and asked for a Driver's Attestataion, something we have never heard, all of our work/billing was done electronically. What we gathered from their request is that they issued jobs for Medicaid and Medicare without their approval and was not paid and now they want us to payback. The reason for this belief, is the information that they asked for:
1. History and Physical, presenting symptoms and complaints, findings on examination
2. Lab test results, x-rays, consultation reports (including referrals and documentation of response back to requesting physician)
3. Daily progreass notes or reports ad records of any medications prescribed relative to the treatment
The above request can only be obtained by a Health Care Professional and not a Livery Car Service, this is soemthing that woudl come from Medicare/Medicade going to the insurance company. In accordance with the Hipaa Rules and Regulations, we as a car service, this would be illegal for us to have such information.
At one point, Health first reported all the money that was billed to the IRS advising them, that is what they paid us, someone at the car service jumped the gun and advised HealthFirst of this, they supposidly sent a retraction.
We have sent a letter to all the Corporate officers and so far no replies.