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Lawsuit Against Moda For Failure to Pay Claims Within 30 Day Window

Tuesday, March 28, 2017   (0 Comments)
Posted by: Brook Schales
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Laura Farr | OANP Executive Director

Acupuncturist Jonathan Schell has contacted OANP about a class action lawsuit he is preparing against Moda for failure to pay claims within the 30 day window. If you believe that Moda has regularly paid claims after 30 days, or sends you letters asking for more time to pay the claim without asking for records, your experience might be helpful in getting Moda to comply with the law.

What you would need to collect includes:

1) A receipt of submission for each claim item which has not been paid (such as something that Office Ally provides after electronically submitting records or a submission fax sheet) that shows when Moda received the claim. Redact the patient's name, but leave other identifying information such as dob, insurance number, etc. (This receipt is evidence that Moda received the claim and when exactly they received it.)
2) Any letters from Moda which either ask for more time to pay (for each claim involved); ask for medical records after the 30 day clean claim window has expired; or deny the claim after the 30 day clean claim window has expired (when records had not been requested). (Each receipt when combined with it’s corresponding letter for each case, show a pattern that Moda has been receiving claims, but allowing the 30 day window to expire, yet not paying the claim.)
3) Staple or paperclip each receipt of submission of the claim with the letters that correspond to that claim. (So that each claim item is a contained unit – we may have thousands of records at the end of this if we are looking to do this in five states).
4) Provide a copy of your medical license and your NPI number (the npi number is often on the billing receipt). This proves that you are licensed to practice medicine and to bill.

Send all documentation including a receipt for the cost of making the copies to:
Jonathan Schell
1017 SW Morrison #307A
Portland, OR
97205

You can also check out the Facebook page he has created where this can be discussed at: https://www.facebook.com/groups/106017839916269/

Questions, email jonathan@aletheaacupuncture.com

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OREGON ASSOCIATION OF NATUROPATHIC PHYSICIANS
PO Box 5876
Portland, OR 97228

Phone: 503-262-8586