Insurance Hassle Reporting

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

File a Clean Claim Complaint Form with the KY Dept of Insurance

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
Payer 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 Passport Referrals
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
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