There are several reasons why a medical claim billed to a No Fault carrier will be delayed:
1- awaiting an NF-2 form
2- Assignment of Benefits not on file or incomplete
3- Claim is under investigation
4- Awaiting medical, hospital records, x-ray/diagnostic testing, films-CD
5-Injury was not reported
6-Letters of medical necessity for why certain medical services are rendered
7-Causality Letter- A letter stating why treatment was related to the accident.
8-Patient needs to attend an IME or EUO to determine necessity of treatment provided.
9- No Fault carrier request the police report of the accident.
10- Hit and Run accident - Insured Vehicle information unknown
11- Billing Charges Do Not Line Up With Medical Documentation Provided
Until the carrier receives all the information they requested for their review and records, payment on medical claims submitted for No Fault treatment can be delayed for all the above reasons.
Healthcare providers can be better prepared to limit the amount of delays by obtaining some of the information at the time of treatment by the patient so it can be forwarded to the carrier as soon as possible along with the treatment bill. Providers also must fully document all treatment provided in their physical examination treatment notes that are sent to the carrier. If it isn't documented properly you will not paid.
Important Links:
www.dfs.ny.gov - Link To No Fault Forms
For Hit and Run accidents - Claims are filed with MVAIC . MVAIC will fully investigate all to find out if benefits are payable through MVAIC or household auto insurance of the injured patient.
Click here for more information on filing with MVAIC-
All About MVAIC
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