Q: HOW IS MIDWIVES ADVANTAGE DIFFERENT?
Midwives Advantage is a corporation, like a trade union for midwives, working together to get midwives paid through insurance. We have better collective bargaining powers than an individual practitioner. Healthcare providers become contracted employee providers of our corporation; therefore, claims process through our corporate agreements. Claims are billed using the corporate tax ID numbers, not the midwife’s social security number or EIN. We process millions of dollars in claims each year, and as a result, we have a better position with the payers than an individual practitioner or a birth center.
Q: WHAT ADVANTAGE DOes MIDWIVES ADVANTAGE give me?
Claims submitted through our company are billed at nationally recognized rates; therefore, most midwives enjoy the benefit of being paid at a higher rate. We submit over 20 million dollars in claims every year and have more bargaining power as a group. The healthcare provider is responsible to accurately report services provided but not personally responsible for the way claims are submitted. Midwives can focus on providing patient care; instead of learning coding and billing.
Q: CAN PROVIDERS CHARGE DIFFERENT PRICES for cash pay and insurance patients?
Laws vary from state-to-state, but generally, the answer is yes. In-network providers agree to charge cash pay and insurance clients the same rate; however, if you do not have a contract, you can use a different fee schedule for clients with varying circumstances. Healthcare practitioners can offer a pre-payment discount. This practice is similar to negotiating a discount with insurance payers.
Q: WHAT ARE STANDARDS FOR DOCUMENTATION OF HEALTHCARE SERVICES?
Medical record documentation standards are established on state and federal levels for professionals that provide health care services. Documentation records need to be legible and chronological. Documentation is required to submit claims.
Q: ARE THERE ANY PAYERS TO WHOM YOU DON'T SUBMIT CLAIMS?
We do not submit Medicaid or Medicare.
Q: Can I FILE CLAIMS WITH BCBS?
BCBS claims pay as long as the plan allows for out-of-network services and maternity care.
Q: How do Providers get paid for claims?
The insurance company sends payment to our corporate offices, we deduct our fees and send the balance to the provider through direct deposit. Payroll is processed every two weeks and funds are deposited into the provider's account on Friday. A spreadsheet of all payments is sent to the midwife every pay day so the midwife is aware which claims have processed.
Q: WHO IS RESPONSIBLE FOR THE CODES ON THE CLAIMS?
A: The biller, not the healthcare provider, is responsible to make sure all billable codes in the health record are submitted accurately on claims.
Q: CAN A PAYER COME BACK ON A MIDWIFE AND DEMAND MONEY FOR CLAIMS PREVIOUSLY PAID?
Payments are made to the corporation. This structure allows are legal department, instead of the individual provider, to communicate with the payer on refund requests. We do not refund money to payers on legitimate claims.
Q: CAN AN INSURANCE COMPANY REVERSE A PAYMENT?
Insurance companies sometimes request a refund after a claim has paid. We have a legal department that responds to all request for refunds. If services were rendered and billed correctly, our financial department sends the payer a written denial to the request for a refund.
Q: HOW DO I GET STARTED?
- Complete the Request Information form.
- You will receive a call from a supervisor to explain how our company operates and to answer any questions you have.
- You will receive a log in to a secured page on our site and have access to our contract and sign-on information.
- After registration items are finished, you can submit claims immediately.
Q: CAN I FILE FOR BIRTHS THAT HAVE ALREADY OCCURRED?
Midwives can file claims for the previous 12 months. This allows midwives to get paid for services when the client still has an outstanding balance. It also allows the midwife to reimburse clients that have paid for services out-of-pocket! It is a risk-free way to test-drive our services!