3rd Party Billing Groups

I work in a claims department for a well known health insurance company and I find it crazy that almost every provider contracts their billing and claims to 3rd party data centers halfway across the world even these callers most of the time don’t even understand what they’re talking or asking about or they disregard information they are told and do things their way I’ve gotten claims all the way back from 2022 not being able to be paid out because these 3rd party companies not only is the language barrier tough but they do not understand how American Medicaid/medicare work nor do they understand simple guidelines I’ve had multiple instances where they resubmit claims over 15 different times with no change I have almost every single claim I go through deny because these 3rd party callers don’t understand what they are doing and even after that when we try to resolve the issue 9/10 they disregard what information I provide not only that they disregard HIPAA so much it’s insane whenever I state that they are calling the wrong state plan or can’t find member info with what they provided me they just throw around members social security #s and information like nothing amazes me there are no guidelines, regulations, or laws for this it affects so many people everyday it’s crazy that we allow this to happen the extent it does if you had a claim deny it’s probably because the 3rd party company your provider is contracting their billing to

submitted by /u/user38097
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