Is it defrauding the Insurance Co. if a vehicle calls for a nags # But, there is an interchange part that is cheaper and you use that part instead?
You charge the Insurance Co. for the higher part #?
Fraud? If so, I would love to see SGC audited to find out if and how many times they have done this nationwide. If they have, we could be talking $$$$$$ in insurance fraud.
If this was actually happening of course. I am just curious.

Lynx rejects invoices for interchange part #s a lot of the time if theyre List is higher than the obsolete number it is replacing funny that if the shoes on the other foot and pricing is less theyre OK with it .

Bottom line as long as it serves them its OK if it helps a glass shop make a 1.00 more on a ticket its probably criminal .

Have seen this on a lot of Mopar stuff like Jeep 1/4 glasses and the never ending caravan parts superceding each other.

Why can't they keep up, when was the last time anyone actually installed a FW799, and not a 2011, same list price but none of our vendors (at least) carry 799's anymore. So we install 2011's and edi invoice 799's, I believe not 100% on this I'm on the counter, phone and in the books try to stay outa the shop, but a 2011 manufactured by "ULN" has Toyota emblem on it, we get them thru Mygrant
And I have had Lynx reject invoices because due to incorrect list I had billed them too little, blew my mind but ok I'll change the invoice and thanks for catching my error.

It is just as much fraud as when people bill out for new moldings, but save the old ones, and reuse those instead. If that could actually happen.

Not sure which software ya'll use but if NAGS shows a w/s interchanging such as FW00799 WITH FW02011 an invoice will not be rejected thru EDI. I do it every day, never had a problem as long as NAGS shows the interchange.

If the interchange price is different, Which price do they use? If you bill for higer interchange will they pay it? Do they only not reject if the list prices match?

Seems like the safest approach would be to bill for what you installed. Could avoid FBI on your doorstep.

what interchange are you speaking of? are they actual interchanges or just both will fit the hole? if they are interchanges don't they usually have the same list? give an example.

I haven't tried recently, (last 12 months or so) but when I first began working here and edi invoiced a FW2011, my invoice was rejected "incorrect NAGS glassmate part" exact reason for rejection, went back into edi pulled up invoie changed it to FW799 and it was paid. Now maybe since last time I attempted it they have caught on to the obsolete part no, assuming it's obsolete....it's unavailable anyway. Other than a situation like this we always bill what is installed. Is it fraud if you install a w/s using universal molding and bill corresponding precision molding number?...Even though the universal cost more than the precision molding would, as you know some precision or comparable AM molding cost only $5-$6, listing for $10-$12 and the universal we use cost no less than 10-24 bucks per application.

Yes Hal But the question is:
If only the interchange is available and it's list price is either higher or lower which one do you bill?
Will you get paid the higher $$ if interchange is higher?

If interchange is lower but you bill for unavailable part called for, is that fraued?

Well if we can expect the FBI visit, Than so could The insurance/TPA companies for forcing us to bill for a part that is no longer available (works both ways). If you stick to the O/A and bill what they tell you and install what is available through your distributors and print the # that the TPA tells you than you are not defrauding any insurance companies,the TPA is and you are just following the O/A. My dad went through this in the late 80's just as the TPA started taking control.The lawyer brought up the above statements and sent a letter to the insurance company and the TPA and they dropped it all. Our companies didnt do anymore work for the TPA's until about a year ago.

Hey AH-A/G

Curious, after being out from under the for so many years, why did you start back recently. I see many shop owners/managers on this forum who say they do not bill thru TPA's or belong to them, that they instead direct bill....I was unaware this was an option, and even if you direct bill you still have to abide by their (various ins co's) rates or backbill the insured, right or wrong? CAN you bill an insurance company direct using your own pricing guidelines, based on (imagine this) your own costs if you aren't a participating member of their glass program? Anyone feel free to answer this one!

"I see many shop owners/managers on this forum who say they do not bill thru TPA's or belong to them, that they instead direct bill....I was unaware this was an option, and even if you direct bill you still have to abide by their (various ins co's) rates or backbill the insured, right or wrong?"

Wrong.

"CAN you bill an insurance company direct using your own pricing guidelines, based on (imagine this) your own costs if you aren't a participating member of their glass program?"

Yes.

Say what,If you have enough walk in ins work,get off networks.You can and will make more profit doing it this way than doing work with networks.Even if you have loyal agents that call them in for you just tell them to have the customer talk to you to set everything up.We used to be on networks because the agents would just call them in.Now it is easier for the agents and we make alot more profit to do it this way.Just give your agents your local or toll free # and that is all they have to do.Both sides win this way.

We only got back on the network because Allstate told one of our largest customers that they could not use us unless we had an O&A with Lynx and Allstate. We seen the # of jobs that the body shop turned down becasue of us and we decided that we would go ahead and give it a try again.

Mark 1

Thanks for the info, almost an overload though I'm going to try and process the information now.
I have read alot of your posts and replies and know you are very intelligent, and extremely educated regarding your chosen profession, some of your stuff looks as though it could have been written by a lawyer. So now that you gave me the basics, "WRONG" & "YES"...I guess I'll do my homework and try and educate myself more on the subject....Really Thanks.

Good Luck

Apologies, Don't Panic, but Say What kind of asked for the yes or no, right or wrong replies.

In the interests of a short post by myself, and just to prove that I can write a short post, I did. lol

Also, I tend to not post "what works" in front of insurers regarding avenues of direct billing. THose avenues seem to quickly have road blocks put up on them.

For example, I had a really really nice conversation with a very polite lady at an insurance company the other day while helping one of her customers that was traveling through here. The conversation turned to the topic of customer complaints in general; complaints for poor work. This nice lady handles those complaints as her primary job. WHat she revealed to me about the content of complaints, amount and frequency of them was very interesting. We exchanged phone numbers and credentials, and have forged a nice working relationship for the future, for the benefit of my customers, and hers.

One must wonder why, with the network in place to deal with this, this lady has this job at the insurance company. Seems that these complaints are not handled well by the network on a regular basis, hence her job exists to intervene and solve them. She now has a source in this area to send her customers, that will give her a documented report of what was found, what was done to correct the problem, and the insurer is willing to pay for the service. Gee, what a concept!

I'm not going to mention the insurer, or the network they use, for the reasons above. I will say that I believe that there are decent insurers out there, and we seek them out to reccommend our customers to. I will also say that I believe that many insurers, or at least the people at the top, are out of touch with things that are going on with their customers due to networks, but the people in the trenches know quite well.

And BTW, no, I'm not a lawyer, and I don't give legal advice, I just try to listen to lawyers that do.

This has nothing to do with this threads subject but, somebody tell me something please, I'm kinda new to the forums and never been in a chat room, don't do the text message thing, so my question is WHAT IS "BTW"? I got the LOL and the ROTFL or ROTFLMAO and the OMG but I can't put anything with BTW , I know I'll be sorry I asked because it's probably so simple Gump could figure it out.

BTW - by the way.

IMHO or IMO - in my humble opinion or in my opinion.

I knew it would be simple, as i apparently can be at times. Thanks Webmaster......have a great day!

While we are on this explain lol, thanks.

lol = laugh out loud
rotfl = rolling on the floor laughing

The ones Bachman uses would be censored by the forum program so I can't explain those.

Brian is that a slam against me?

Not a slam. Maybe a dig. If this is Larry who posts as Bachman among others. I'm not sure because your IP is different today. I was referring to the fact that whomever was posting as Bachman at the time always included the mfao after the rofl.