Introducing a new tool and process to help us better address your claim questions
Working in collaboration with our network physicians and practitioners, Empire is introducing a new tool called the Claim Research Template (CRT) on March 1st, 2010.
Our Physician Network Management team consists of consultants that focus on ensuring that our network physicians and practitioners understand our processes, policies and procedures. In addition, our team focuses on informally researching claim concerns. To facilitate both the education and informal research process, the CRT has been created to ensure that Consultants have the necessary information to complete informal research on your claim concerns.
Please note that the CRT does NOT replace the standard claims grievance process. It is to be used when physicians and practitioners have concerns impacting multiple claims and will help facilitate the collection of certain information so that Empire may conduct further research, and seek to informally resolve claim issues raised by providers.
The CRT template should be used when all of the following conditions are met
| You are a participating provider in Empire’s network(s);|
| You would like further research conducted after contacting Provider Services or after receiving a denial once the grievance process has been completed; and|
| You have five (5) or more claims which have the same concern (excluding administrative, benefits and eligibility and medical policy denials).|
The template should not be used for any of the following situations:
| By providers not participating in Empire’s network(s)|
| Prior to submitting claims to Empire|
| For general claim status|
| For member benefits or benefit verification; or member eligibility|
| For administrative denials (Example: denial for lack of referrals/pre-certifications)|
| For coverage denials (Example: member ineligible, services not a covered benefit)|
| For medical policy review.|
The process is as easy as 1-2-3:
2. Complete the CRT to include no more than five (5) claim examples which have the same concern.
3. Forward the CRT to our secure, dedicated email address at ClaimResearchTemplate@empireblue.com. For the subject line of the e-mail, use the physician and/or practice name and the primary zip code for the practice.
If you have any questions about the CRT template or new process, please contact your dedicated Network Management Consultant whose phone number can be obtained by calling 800-992-BLUE (2583) and selecting the following prompts in order:
| Option 1: Medical providers|
| Option 4: Provider updates and other information|
| Option 1: Participation and credentialing information |
| Enter your zip code |