Coventry Incorrectly Processing Bills December 2015

Review all EORs processed by Coventry

A DaisyBiller identified an error affecting a portion of bills processed by Coventry from December 13th-15th, 2015.

A Coventry representative described the error as a ‘glitch’ in Coventry’s processing system which caused erroneous contractual adjustments for bills processed from December 13-15, 2015. Coventry incorrectly applied contract discounts, resulting in underpayments to providers.

DaisyBill’s Compliance Team reviewed several EORs affected by the Coventry error and confirmed that only a single line item was paid, with additional lines items denied using the denial reason ‘Network Discount’ or ‘Coventry-Owned Contract.’

Required Action

Carefully review all Coventry-processed Explanations of Review (EORs). Coventry reviews bills for several claims administrators, including Sedgwick.

For Incorrectly Processed Bills

  1. Upload the paper EOR to the Bill in DaisyBill.
  2. Submit a request for Second Review for additional payment citing your practice’s correct contract terms.
  3. Alert DaisyBill’s Compliance Team by opening a Support Case; be sure to include the DaisyBill Bill ID.

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