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Understanding Your Insurance Concerns
Understanding Your Insurance Concerns

We're here to help with understanding clawbacks, audits, and what to do if payment gets sent to the therapist.

Updated over a week ago

De-Mystifying your Common Insurance Fears:

What are clawbacks and how are they handled?

Clawbacks, also known as recoupments, occur when an insurance company requests the return of money it previously paid for a claim. This is common when you’re an in-network provider and are processing in-network claims.

At Mentaya we only handle out of network reimbursement, therefore clawbacks are not applicable.

What happens if payment is accidentally sent to me?

If you receive a reimbursement check from the insurance company, most likely the insurance company has a policy where they pay the provider instead of the patient if we submit these claims.

Here are a couple of options on how to move forward:

1/ We can void the claims and refund our processing fees. Once we do, the insurance company will send a request for those checks back. Please wait until you receive the request and send the checks back with that notice. If your client decides to submit these claims on their own, there’s no guarantee that this won’t happen again.

2/ The other option (and the one we would recommend moving forward) would be to set you up under our NPI/EIN in their system, so the payments should get sent to us, and we can take care of then rerouting the payment to the client.  If you'd like to do this, please sign a Management Services Agreement, and upload it to the documents section of your profile. We’ll take care of the rest!

Should I be worried about audits?

Audits for out of network claims are extremely rare! However, if they do happen Mentaya is here to help.

Remember: Don't hesitate to reach out to Mentaya's support team if you have any questions or concerns about clawbacks or audits. We're here to assist you throughout the process.

Related questions: What happens if payment is sent to me not my client? Will I get audited? What is a clawback?

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