One insurance company, three products, three fee schedules
Many insurance companies sell commercial plans, Medicare plans and Medicaid plans under the same name. If your system lists them as one insurance, it can't tell them apart, and neither can your reports.
Each product has its own fee schedule, filing deadline and rules for who pays first. Lump them together and the system can't apply any of those correctly.
Warning signs
- One insurance name in your system covers patients on very different kinds of plans.
- Your payer mix report shows a single line for a company you know sells several products.
- Underpayment reviews come back "inconclusive" for your largest payers.
What it costs you
Your payer mix has no integrity, so contract and staffing decisions rest on the wrong picture. Underpayments slip by, because there's no single expected rate to check a payment against. (Example only: if one product pays 80% of what another pays for the same service, a combined record can hide a shortfall on both.)
Ask your billing team
"For each insurance company we bill, do we have a separate setup for each product line?"
What fixing it gets you
A payer mix you can trust, and the ability to catch every payment that comes in short.