Status messages are crucial to determining the level of payment on the claim. The information here will help you understand these messages.

On occasion our Third-Party Administrators (TPAs) will ask us to alter codes as submitted by the provider to mirror codes identified as appropriate by their bundling software and to obtain corrected repricing. We are not able to assist with these requests.

Creating a Clear Explanation of Benefits Clear Explanation of Benefits (EOB) and Provider Remittance Advices are very important.

Creating and issuing accurate ID cards guarantees that employees receive appropriate Alliance savings. It also prevents misdirected claims and telephone calls, and leaves customers satisfied.

The Alliance repricing reflects multiple surgery and other modifier reductions where appropriate.

Many Alliance participating providers have agreed to accept Alliance repricing as full payment whether or not the service is a covered benefit under the plan, and whether or not the employer, their plan administrator, or the employee is responsible for the charges.

Timely payment of claims is important because claims that remain unpaid for more than 30 days may result in the loss of The Alliance negotiated fee to the employer/employee.

Has your organization ever received a claim repriced that references the Non-participating Provider — Usual and Customary applies. Pay “Repriced” amount and U&C?

The Alliance does not reprice all claims.