The following is a list of frequently asked questions compiled to assist you in some of the most common areas of confusion that may occur as you implement the First Source Medical Repricing program.
How do I send bills to First Source for repricing?
What kind of bills do I send?
What information is needed to reprice medical bills?
What is the turn around time for bills submitted to First Source?
What happens to bills that fall outside the First Source contracted network?
May we get a list of contracted providers in our area?
Do all contracted providers adhere to the same rate schedule?
How do we pay First Source fees?
How do I send bills to First Source for repricing?
The most efficient method of sending claims is to fax the completed First Source Claims Repricing Transmittal sheet and the bill summary page (UB92, HCFA 1500, etc.) to First Source fax: (602) 358-7444. But, if you would like to submit your claims electronically First Source will customize an electronic interface for your use.
What kind of bills do I send?
All medical bills that you want discounted, may be submitted to First Source for repricing. This would include hospital (inpatient, outpatient, emergency room, etc.), physician, chiropractic, physical therapy, ambulance, etc.
The only bills you would not send are those where you have established other vendor and/or direct relationships for services, i.e., utilization review services, PPO direct contracts.
What information is needed to reprice medical bills?
Complete the requested information on the fax transmittal form for each bill submitted (date, # of pages, Claim #, Percentage Responsible to Pay, Deductible) and fax with the UB92 or HCFA 1500 statement. Itemized documents are not required to reprice the bill. If the UB92 or HCFA 1500 is not available, fax what information is available.
What is the turn around time for bills submitted to First Source?
Turnaround time is 72 hours (3 days). Over 82% of all bills submitted are returned within 1.2 days. If a bill has not been returned within 72 hours, a First Source representative will contact the rep that submitted the bill for explanation. Most bills that exceed the 72-hour limit are out-of-network bills which require direct contact and negotiation with the provider. If the decision-maker at the provider location is not available, it may require additional time. Your claims rep will be asked for permission for additional negotiation time, if we go beyond 72 hours.
What happens to bills that fall outside the First Source contracted network?
When a bill is received that does not match the First Source network, it is forwarded to the negotiation department to attempt a prompt pay discount on your behalf. In most instances, the provider will accept a lower fee if payment is received within 5 to 12 working days.
First Source maintains history of all out-of-network providers and is able to determine any restrictions they may have such as dollar thresholds, age of bill, etc. And, of course, direct contract negotiations always takes place with those providers as well.
May we get a list of contracted providers in our area?
Yes. Although First Source will attempt to negotiate all bills submitted which fall outside of the contracted network, an updated listing may be obtained upon specific request for a geographic area.
Do all contracted providers adhere to the same rate schedule?
No. Contracts are negotiated separately, either by individual provider or groups such as health systems, PHO's or IPO's.
How do we pay First Source fees?
First Source fees may be paid bill by bill or you may utilize the month-end Statement of Account. When making payment bill by bill, the First Source Control #/Invoice # should be identified for proper posting. If payment is made using the month-end Statement of Account, identify the billing period and any adjustments you may make from total amount due.
