Managed Care Advisory Group
 6641 Sylvania Avenue
 Sylvania, Ohio 43560

 1-800-355-0466

physicianservices@mcaginc.com

Get What’s Coming To You.

Ingenix Settlement Management

UPDATE:

MCAG believes efforts to file claims into and administrate the UHC Settlement are progressing well.  Although the filing is complete, we will not be able to report the estimated returns or timing of payments, with any accuracy, until August at the earliest.  However, it is anticipated that payments will likely be made before the end of 2011. 

 

We expect that payments may be as much as 10 to 12 cents per dollar submitted. 

 

As you may remember, the fund is a fixed fund (estimated at less than $200 million) – if the fund is oversubscribed, which we expect it will be, all payments will be reduced on a pro-rate basis.  

 

In the meantime, please feel free to contact a MCAG representative if you have any questions, or if we can be of any further assistance. As always, the settlement process requires patience and diligence. MCAG will continue to keep you informed.

---

 

After years of effort, the American Medical Association has settled a class action lawsuit with United Health Group (UHC) resulting in a major victory for providers.

UHC will pay out $350 million dollars in claims to settle allegations that it manipulated the Ingenix Database, creating lower reimbursement rates for out-of-network charges. The Ingenix Database was used to determine “usual and customary” rates and by methodically lowering those rates it was alleged UHC was able to pay less than market rates for medical services, forcing providers to take a loss or balance bill patients for the difference.

While over $350 million will be available to physicians and patients to submit claims against it will not cover the total loss incurred by providers, creating a mad rush between now and October 5, 2010 to submit claims. Providers will be required to reconcile their claim history over the last 15 years, 1994 to 2009, with a record generated by UnitedHealth Group. Providers will also be required to submit additional information regarding patient pay and balance billing procedures to obtain additional claim dollars.

The reality of health insurance payer settlements are that they are often more complicated than they appear. Managed Care Advisory Group (MCAG) specializes in working through the requirements and creating a hassle free experience for providers trying to recover lost dollars.

• MCAG will review all your eligible claims to ensure that every eligible billed procedure is included in your filing, not just the ones UnitedHealth Group was able to locate. (Click here to see a list of the UHC Payers covered under this settlement)


• MCAG’s team of experience staff will handle all the labor intensive review and filing processes, including the reconciliation process to ensure that the settlement administrator did not disregard legitimate claims


• MCAG has years of expertise in dealing with claim data and payer settlement actions, collecting over $200 million on behalf of our clients in the past several years.


• MCAG retains a small percentage of the money recovered as payment for services. Clients who have filed claims themselves and with MCAG report that the maximized return MCAG achieves more than offsets the fees charged

Deadlines are fast approaching and 15 years worth of claims will need to be reviewed and submitted to the settlement administrator prior to October 5, 2010.

MCAG clients don’t miss deadlines. MCAG clients get the maximum return on their lost claim dollars. Act now to get the benefits from this settlement and take advantage of the experience and expertise that Managed Care Advisory Group brings.

MCAG clients only need to take a couple of steps to be protected and ensure a filing:

• Fill out our online enrollment form or call 800-355-0466


• Provide MCAG with a listing of any and all Tax ID number(s) that your practice or facility used to submit claims


• If you can, tell MCAG which UnitedHealth Group plans you did business with (we have a list)


• Identify your clearinghouse and/or practice management system that we can work with to obtain a record of your eligible claims

This class action settlement is just the first Domino to fall in the Ingenix – UCR (usual and customary) cases. Many other insurers used the Ingenix database and the artificially reduced rates to determine payment for their own out of network claims. In the very near future those other insurer payers will settle their own cases, leading to even more dollars available to providers who were artificially underpaid. MCAG will continue to be at the forefront of those actions, ensuring a fair claim process and working with our clients to identify eligible lost dollars and file class to recover those loses. Providers can also look forward to a new database which is being developed by non-insurance entities to set payment standards that will not be subject to payer manipulation.