Recently, a few of my practices have experienced major delays in payment due to payer system changes and updates.

To be specific, one that had been billing under an individual NPI (for ten plus years) to Blue Cross learned that this was no longer acceptable and had to be changed to the group number. Shortly after receiving this information the doctor was inundated with take back after take back for previously paid claims (under the individual number). All those claims were then rebilled under the group.

Easy, right???
Wrong. In some cases payment took six months or more to process. It was only after a formal grievance was filed that payments began to be seen in a “timely” manner.

The second is an issue specific to TriCare East who recently changed their payer ID (the electronic address where claims are sent).
In the process, ERA and EFTs were “undone” meaning that contracted doctors are now receiving paper checks (instead of electronic payment until re-enroll is complete). For one of my docs, payment is being mailed to an old (years old) address, causing both frustration and major delays in reimbursement. Months later the doctor is still waiting for the issue to be resolved.

The third is related to EHR/PM systems that are choosing to change clearinghouses. One example is Nextgen who previously had their own and now is using Waystar. During this process (involving new EDI enrollment which is different for each payer) delays in payment have become an issue.

If you are not being affected by anything like the aforementioned… good for you! Please keep close tabs on “days to pay” though as you never know…