On 12/5/15, Our Customer Service Department was able to reach the member and advise her that she is showing eligible back to 5/1/16. She will fax or call us about the billing information so we can reach out to the provider. Once that information is received, we will loop in our Claims
Management team as this claim is past the timely filing deadline
Good afternoon, our customer service team continues to speak with the member in an attempt to collect the claims that were denied. Our initial research shows that the provider filed the claims under the wrong group because it states HHW instead of HIP which is what the member is on. We have requested for claims to look over those claims
Our Customer Service Department spoke to her yesterday and submitted a request to Provider Relations to help with the bills she is receiving (see attached). We were able to retro her eligibility to 5/1/16, allowing her claims to be covered. We need for the provider to resubmit, which is the purpose of the request to Provider Relations to assist with resubmission of the claims and waiving the timely filing for these so that the claims can be paid. I believe she filed the Revdex.com again because she interpreted the timely filing issue stated in our response to the Revdex.com as her failure to have the claims paid timely
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to meHowever, it should not take months of repeated phone calls and, eventually, a complaint to the Revdex.com to resolve an issue like thisI am satisfied with the resolution, but have been wholly unsatisfied with the way that MDwise has handled this issue
Regards,
*** ***
The contact that Mr*** was working with was out of the office during the week of October - Mr*** was contacted on 10/31/regarding his concernsWe are still trying to address his concerns with the hospitalWe will continue to update Mr*** as we attempt resolutionShould Mr*** have any questions, he may contact Morgan G*** at mg***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I was contacted by Morgan G*** and she told me she was faxing a settlement offer to the hospital.After leaving many messages for Morgan over a weeks period of time and not getting any response, I decided to call the hospital.The hospital never received any communication from MDwise at all.Since then, I have left many more messages, both email and phone for Morgan...........She will not contact me.Please have someone call me and let me know whats going on...PLEASE
Regards,
*** ***
We researched Ms*** concerns regarding the denial of her two claimsShe was, in fact, enrolled for the dates of service in questionWe are working to reprocess those claims as they were denied in errorWe have contacted Ms*** to explain this processWe apologize for the
inconvenience this has caused and will continue to update Ms*** on the status of her claimsShould she have any further questions or concerns, she may contact Morgan *** at 317-822-
We have updated the entire family’s paid through date in the systemTheir paid through date now reflects 04/30/2016. Additionally we reached out to the pharmacy on April 11, The e claim child’s medication was paid and Mrs*** was notified when prescription was ready for
pickup. We apologize for any inconvenience. Please call our outreach department directly for any further concerns at 317-822-
Good afternoon. MDwise reached out to Mr*** and explained that the remaining balance on his account is the pro-rated amount left over from his mid-month cancellation due to enrollment in the Healthy Indiana PlanThe past due balance on the account must be paid for February,
coverage to begin. We apologize for any inconvenience this has caused Mr***Should he have any questions he may contact Morgan G*** at 317-822-***
The member had a change to their enrollment file from HealthCare.gov effective 4/16/that contained an error and required a manual correction. Once the error was identified, the enrollment record was corrected and all pharmacy claims have been reprocessed. MDwise has ensured that the
member’s coverage is active and up-to-date in all systems.MDwise works hard to identify any errors with incoming enrollment records from HealthCare.gov before our member’s care is impacted. Once an error is identified, it is our top priority to resolve the errors as expediently as possible. We regret that this member experienced problems with payment of their pharmacy claim, and are pleased that we were able to resolve the member’s issue to ensure correct claims processing going forward
MDwise has attempted to reach out to Mr*** at 11:AM, Tuesday, March 1, and left a voicemail with a direct number to a customer service manager for a return call. He also left messages at 3:PM, Tuesday, March 1, and 11:AM, Wednesday, March 2, 2016. As of
today, we have not heard back from Mr***. Mr*** became an active member with MDwise under the HIP Basic program on January 1, 2016. MDwise is required by the State to complete a Health Needs Screening for 70% of our members within days of the date we receive notification that the member is eligible and active. The day mark for Mr*** is March 30, 2016. MDwise is deeply committed to meeting our Service Level Agreements with the State. This is why the phone number for Mr*** was placed in our automatic dialer, along with the 1,other members reported active on January 1, 2016. During that time, our records indicate that Mr*** was contacted one time on February 29, 2016. He indicated to the customer service representative that he is ordering us to stop contacting him. Upon this notification, the phone number for Mr*** was entered into our Do Not Call list and removed from our automatic dialer systemThe personal information of our members is never sold. Any information discussed during the Health Needs Screening is protected under the HIPAA and HITEC acts. The first question of the of the Screening also allows members to refuse sharing of the information with MDwise care management staff and the members provider if they so desireThe gift card referenced by Mr*** is accurate. By completing the Health Needs Screening, a member will earn member reward points, which is enough to redeem for a $gift card. However, the members can also earn additional points throughout the year by setting up an online account with MDwise, tobacco cessation, completing their annual physical, and glucose testing, which could earn them enough points to redeem for a $gift card. The reward points and gift card are not a prize, but simply a way for MDwise to say thank you to our members for taking an active role in their health and well beingPlease let me know if you have any questions
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
The contact date should read 12/05/not 12/05/15, while the date of eligibility should be 05/01/not 05/01/
Regards,
*** ***
MDwise does not make eligibility determinations. We contacted DFR and the State has opened her in Plus effective 4/in their system. I can confirm that member is open and has a $Power Account Payment from 4/1-on. Open means active coverage and she should begood to go
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** *** I believe this to be a blatant lieMDwise is not a physician or even a medical practitionerTheir own website clearly shows they are attempting to give out medical advice in the form of flu vaccines.The rhetoric contained in the response is not trueAny further telephone dialog attempted by this company will be taken as harassmentI will not sell them my personal medical information for their nefarious purposes.I am further insulted the response insinuates I am a user of tobacco products
Mr*** was enrolled at the date of service and his claims were denied in errorWe reprocessed the two claimsThe claim for date of service February 8, has not paid yet, but is currently being adjudicatedThe second claim for date of service March 15, has been paidWe apologize for
the inconvenience this has causedShould Mr*** have any further questions he may contact Morgan G*** at m***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to me.
Regards,
*** ***
RevDex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I require a refund of fees I was forced to pay due to your company's failure to provide the services I paid for. The fees I have paid are accessible through my account, and the money it has cost me is known to your business. Please rectify this situation
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to meMy portal and 'my mdwise' page has been updated and mdwise has resubmitted the claims that showed, in error, that we did not have insurance.However, I still need to wait and see if my claims that have been resubmitted will go through and I would like to make sure that my husband, ***'s account shows that he had met his deductable as it was noted on an earlier claim of his in July 2016.Thank You!
Regards,
*** ***
I have contacted Ms*** and assured her that I am working on her issueI have reached out to the billing departments of both companies and I am awaiting their response regarding Ms*** claimsI will continue to keep Ms*** informed on the status of her claimsI sincerely apologize for
the inconvenience this has caused herIf Ms*** has any questions, she may contact me at 317-822-or mg***@mdwise.org
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Regards,
*** ***
On 12/5/15, Our Customer Service Department was able to reach the member and advise her that she is showing eligible back to 5/1/16. She will fax or call us about the billing information so we can reach out to the provider. Once that information is received, we will loop in our Claims
Management team as this claim is past the timely filing deadline
Good afternoon, our customer service team continues to speak with the member in an attempt to collect the claims that were denied. Our initial research shows that the provider filed the claims under the wrong group because it states HHW instead of HIP which is what the member is on. We have requested for claims to look over those claims
Our Customer Service Department spoke to her yesterday and submitted a request to Provider Relations to help with the bills she is receiving (see attached). We were able to retro her eligibility to 5/1/16, allowing her claims to be covered. We need for the provider to resubmit, which is the purpose of the request to Provider Relations to assist with resubmission of the claims and waiving the timely filing for these so that the claims can be paid. I believe she filed the Revdex.com again because she interpreted the timely filing issue stated in our response to the Revdex.com as her failure to have the claims paid timely
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to meHowever, it should not take months of repeated phone calls and, eventually, a complaint to the Revdex.com to resolve an issue like thisI am satisfied with the resolution, but have been wholly unsatisfied with the way that MDwise has handled this issue
Regards,
*** ***
The contact that Mr*** was working with was out of the office during the week of October - Mr*** was contacted on 10/31/regarding his concernsWe are still trying to address his concerns with the hospitalWe will continue to update Mr*** as we attempt resolutionShould Mr*** have any questions, he may contact Morgan G*** at mg***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I was contacted by Morgan G*** and she told me she was faxing a settlement offer to the hospital.After leaving many messages for Morgan over a weeks period of time and not getting any response, I decided to call the hospital.The hospital never received any communication from MDwise at all.Since then, I have left many more messages, both email and phone for Morgan...........She will not contact me.Please have someone call me and let me know whats going on...PLEASE
Regards,
*** ***
We researched Ms*** concerns regarding the denial of her two claimsShe was, in fact, enrolled for the dates of service in questionWe are working to reprocess those claims as they were denied in errorWe have contacted Ms*** to explain this processWe apologize for the
inconvenience this has caused and will continue to update Ms*** on the status of her claimsShould she have any further questions or concerns, she may contact Morgan *** at 317-822-
We have updated the entire family’s paid through date in the systemTheir paid through date now reflects 04/30/2016. Additionally we reached out to the pharmacy on April 11, The e claim child’s medication was paid and Mrs*** was notified when prescription was ready for
pickup. We apologize for any inconvenience. Please call our outreach department directly for any further concerns at 317-822-
Good afternoon. MDwise reached out to Mr*** and explained that the remaining balance on his account is the pro-rated amount left over from his mid-month cancellation due to enrollment in the Healthy Indiana PlanThe past due balance on the account must be paid for February,
coverage to begin. We apologize for any inconvenience this has caused Mr***Should he have any questions he may contact Morgan G*** at 317-822-***
The member had a change to their enrollment file from HealthCare.gov effective 4/16/that contained an error and required a manual correction. Once the error was identified, the enrollment record was corrected and all pharmacy claims have been reprocessed. MDwise has ensured that the
member’s coverage is active and up-to-date in all systems.MDwise works hard to identify any errors with incoming enrollment records from HealthCare.gov before our member’s care is impacted. Once an error is identified, it is our top priority to resolve the errors as expediently as possible. We regret that this member experienced problems with payment of their pharmacy claim, and are pleased that we were able to resolve the member’s issue to ensure correct claims processing going forward
MDwise has attempted to reach out to Mr*** at 11:AM, Tuesday, March 1, and left a voicemail with a direct number to a customer service manager for a return call. He also left messages at 3:PM, Tuesday, March 1, and 11:AM, Wednesday, March 2, 2016. As of
today, we have not heard back from Mr***. Mr*** became an active member with MDwise under the HIP Basic program on January 1, 2016. MDwise is required by the State to complete a Health Needs Screening for 70% of our members within days of the date we receive notification that the member is eligible and active. The day mark for Mr*** is March 30, 2016. MDwise is deeply committed to meeting our Service Level Agreements with the State. This is why the phone number for Mr*** was placed in our automatic dialer, along with the 1,other members reported active on January 1, 2016. During that time, our records indicate that Mr*** was contacted one time on February 29, 2016. He indicated to the customer service representative that he is ordering us to stop contacting him. Upon this notification, the phone number for Mr*** was entered into our Do Not Call list and removed from our automatic dialer systemThe personal information of our members is never sold. Any information discussed during the Health Needs Screening is protected under the HIPAA and HITEC acts. The first question of the of the Screening also allows members to refuse sharing of the information with MDwise care management staff and the members provider if they so desireThe gift card referenced by Mr*** is accurate. By completing the Health Needs Screening, a member will earn member reward points, which is enough to redeem for a $gift card. However, the members can also earn additional points throughout the year by setting up an online account with MDwise, tobacco cessation, completing their annual physical, and glucose testing, which could earn them enough points to redeem for a $gift card. The reward points and gift card are not a prize, but simply a way for MDwise to say thank you to our members for taking an active role in their health and well beingPlease let me know if you have any questions
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
The contact date should read 12/05/not 12/05/15, while the date of eligibility should be 05/01/not 05/01/
Regards,
*** ***
MDwise does not make eligibility determinations. We contacted DFR and the State has opened her in Plus effective 4/in their system. I can confirm that member is open and has a $Power Account Payment from 4/1-on. Open means active coverage and she should begood to go
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** *** I believe this to be a blatant lieMDwise is not a physician or even a medical practitionerTheir own website clearly shows they are attempting to give out medical advice in the form of flu vaccines.The rhetoric contained in the response is not trueAny further telephone dialog attempted by this company will be taken as harassmentI will not sell them my personal medical information for their nefarious purposes.I am further insulted the response insinuates I am a user of tobacco products
Mr*** was enrolled at the date of service and his claims were denied in errorWe reprocessed the two claimsThe claim for date of service February 8, has not paid yet, but is currently being adjudicatedThe second claim for date of service March 15, has been paidWe apologize for
the inconvenience this has causedShould Mr*** have any further questions he may contact Morgan G*** at m***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to me.
Regards,
*** ***
RevDex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I require a refund of fees I was forced to pay due to your company's failure to provide the services I paid for. The fees I have paid are accessible through my account, and the money it has cost me is known to your business. Please rectify this situation
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to meMy portal and 'my mdwise' page has been updated and mdwise has resubmitted the claims that showed, in error, that we did not have insurance.However, I still need to wait and see if my claims that have been resubmitted will go through and I would like to make sure that my husband, ***'s account shows that he had met his deductable as it was noted on an earlier claim of his in July 2016.Thank You!
Regards,
*** ***
I have contacted Ms*** and assured her that I am working on her issueI have reached out to the billing departments of both companies and I am awaiting their response regarding Ms*** claimsI will continue to keep Ms*** informed on the status of her claimsI sincerely apologize for
the inconvenience this has caused herIf Ms*** has any questions, she may contact me at 317-822-or mg***@mdwise.org
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Regards,
*** ***