One of the most utilized services offered by the GLMS Physician Education and Practice Support Department is Hassle Reporting, where providers can report ongoing insurance issues to GLMS. We work with the payers daily and track issues to identify trends. On average, hassle reports that were resolved have resulted in savings of approximately $2,600 for each physician case.
Since 1998, GLMS has fostered and developed relationships with the insurance payers to ensure member hassles are addressed expediently. The Hassle Report Form, (originally named the Hassle Factor Log) is a steady and growing part of the Society’s functions and is a member benefit that provides a substantial ROI for our members. The communication channels and relationships made between the GLMS PEPS department and the representatives at each insurance company throughout the years are critical to GLMS’ success in assisting with insurance-related issues.
- In order to submit a Hassle Report Form, practices must have a Business Associate Agreement (BAA) on file with GLMS. A blank GLMS BAA may be downloaded here.
- Is your hassle specific to increased hold times with a payer? Click here for a Hold Time Tracking Form
- Is the hassle with a Kentucky Medicaid MCO? In addition to submitting a hassle to GLMS, also complete the Medicaid MCO Provider Complaint Form
Over the years, reported hassles have involved inappropriate bundling of services, nonpayment for certain medications/vaccines or procedures, unreasonable pre-certification procedures, long hold times, incorrectly denied claims, policy issues, improper payer notifications and lack of payer response or follow-up. Frequently, these complaints are not isolated but are found to be a common trend experienced by multiple physician practices regarding the same carrier. For this reason, it is imperative that practices notify GLMS of existing problems so that they may be resolved with the insurance carrier. The execution of the solutions to these problems is followed up by the GLMS staff on a daily basis.
What Hassle Issues are Trending?
Below is a list of hassle topics that have been reported so far. These are issues that have been addressed with payers and some are still in process. If you are experiencing these or other hassles with getting paid correctly, let us know. * Many of these issues have been reported by multiple practices but are only listed once on this list.
|2018 GLMS HASSLE REPORTS by topic|
|All Commercial Payers||Contracting/Network issues|
|ALL Medicaid MCOs||No Shows|
|CareSource Exchange||Denial "No precertification"|
|Humana||CPT 87070 / 93655 / 87651 / 87502 / 86308 / 96110|
|Humana||CPT 99408 denials|
|Humana Military Tricare||Provider Enrollment|
|Medicaid Aetna Better Health||Denial "No Prior Authorization"|
|Medicaid Aetna Better Health/ Coventry||Bilateral procedures|
|Medicaid Aetna Better Health/ Coventry||CPT 77052-26 denial|
|Medicaid Aetna Better Health/ Coventry||Recoupments|
|Medicaid Anthem||Bilateral procedures|
|Medicaid Anthem||CPT 59514-80 denials|
|Medicaid Anthem||CPT 90460 / 99174 / 99408 / 99214 bundling|
|Medicaid Anthem||Denial "not covered for provider specialty"|
|Medicaid CareSource||Bilateral procedures|
|Medicaid DMS||CPT 67900 fee schedule|
|Medicaid DMS||Inmate claims|
|Medicaid DMS||Kentucky HEALTH|
|Medicaid DMS||Medicare Crossovers|
|Medicaid DMS||Provider Enrollment|
|Medicaid Passport||Bilateral Procedures|
|Medicaid Passport||CPT 66984/ 66982 "known issue"|
|Medicaid Passport||CPT 67028|
|Medicaid Passport||CPT 69436-50|
|Medicaid Passport||CPT 76937 denials|
|Medicaid Passport||CPT 99408 / 99174 / 94640 / 92567 Bundling|
|Medicaid Passport||Denial "No Assigned Fee"|
|Medicaid Passport||Denial "No Prior Authorization"|
|Medicaid Passport||Denial "NOC Quantity"|
|Medicaid Passport||ERA issues|
|Medicaid Passport||Global period denials|
|Medicaid Passport||Incorrect ORP Recoupment Letter|
|Medicaid Passport||Mammogram denials|
|Medicaid Passport||Medicare Crossovers|
|Medicaid Passport||Modifier 76|
|Medicaid WellCare||Bilateral procedures|
|Medicaid WellCare||Denial "No Prior Authorization"|
|Medicaid WellCare||Denial "questionable service"|
|Medicaid WellCare||Denial code 701|
|Passport MCR Advantage||Passport Advantage System change|