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It is important to review the patient’s insurance card to determine where the claim should be sent. Claims for patients who are insured through Cigna, HealthPartners and Medica should be submitted directly to those entities. Claims for patients who are insured through other payers associated with Midlands Choice are to be submitted directly to Midlands Choice, where the claims will have the contractual allowed amount applied before being routed to the appropriate payer for adjudication.

 

When claims are incorrectly submitted to the payer when they should be sent to Midlands Choice, circumstances resulting in the delay of provider reimbursement may occur. Doing so may create additional work for all parties due to no electronic tracing or paper trail.  Misrouted claims can easily become lost or cause manual work in repricing and adjudicating which can also add to a delay in payment.

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