Thread regarding Centene Corp. layoffs

Claim denials and low payments

Anyone working in NYS,

Have you noticed since Jan 1st, that majority of the claims being processed are either denied entirely or are processed at a ridiculously low amount?

I’ve seen several claims in which the providers were paid 3% of what they charge.

How is that even allowed?
I saw a claim where the provider billed $250 for a regular check up and got paid $3.30.
Sent it in for adjustment and then got denied saying “contracted rate.”

No wonder more and more providers refuse to take us.

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| 1151 views | | 3 replies (last January 17, 2024) | Reply
Post ID: @OP+1qByQcd3

3 replies (most recent on top)

Isn’t there also a capitation type payment system in NY for the primary’s which would eliminate some of the per visit payments ? Maybe that’s what you saw . Just an idea .

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Post ID: @1iez+1qByQcd3

Devil's advocate, it definitely takes 2 to sign a contract, so blaming Centene completely isn't the whole picture. The provider has to agree to the terms, too.

With that being said, the first thing I wondered is if it was a capitated rate? That could explain the ridiculous reimbursement amount.

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Post ID: @1kpu+1qByQcd3

Not sure about NYS - since I don't work that LOB. BUT it does seem to be a common trend across the board.

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Post ID: @esr+1qByQcd3

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