Provider Alert: Impact of Provider System Changes
Dear Provider,
In the past few months, Sentara Health Plans has implemented several system changes to improve the way we do business with you as a provider. We are seeing some
growing pains along the way, but we believe the end result will be improved functionality for all.
As part of our claims platform migration work, we have confirmed issues for claims with valid authorizations that are denying incorrectly for no authorization, as well as other system-related issues such as inconsistencies with authorization requirements for services. These concerns are being addressed as an urgent priority, and our team is working diligently to identify the root cause of all issues and will be reprocessing the impacted claims in a timely manner.
Providers soon will begin seeing the results of reprocessing, including some impacted claim dates from January 2023. Through this review work, we have identified both underpayments and overpayments to the provider community. We plan to prioritize the underpayments first as we work through the impact of our system changes.
Sentara Health Plans will have ongoing and transparent communication to address these issues. We encourage you to participate in one of our upcoming provider webinars.
If you have any questions, please contact your Network Educator. Thank you for your
partnership.
Sincerely,
Your Sentara Health Plans Team