Facility vs. Non-Facility Misclassification Driving Systemic Underpayments
By Susanna Bekirova, Billing Department, WCH
A systematic reimbursement discrepancy has been identified in HealthFirst claims processing following its 2026 platform migration. A configuration error in the payer’s reimbursement logic has resulted in the widespread application of facility-based rates to claims contractually eligible for non-facility (Medicare benchmark) reimbursement.
This issue is not isolated to individual billing errors. It reflects a structural breakdown in payer-side rate mapping during system transitions, with direct financial implications for office-based providers across multiple specialties.
Affected provider groups include:
| Nurse Practitioners and Physician Assistants from 02/01/2026 | Physicians from March 2026 onward |
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