Submitting the claims online allows for many insurance carriers to make payment on the claims directly without the need for follow up. Most payments are posted within 30-45 days from the time they are submitted by billing.
Underpaid claims (paid far less than usually paid rate as individually determined for each unique plan) and unpaid claims are currently reported in the billing software as a report and require further investigation.
Those which require record requests are handled by the billing specialists, and the claims are reprocessed upon receipt of the supporting records with a follow up within 30 days from the certified mail date on the record request. Phone follow up will happen within one week to confirm the receipt verbally with a reference number noted in our software. The claims will be assigned a status, a user designated for follow up, and a follow up date entered to automatically enter the user’s work queue.
Claims will remain unpaid for several reasons. Claims are rarely ignored for more than 45 days. In the event they are left unprocessed for more than 60 days, a phone call is made to follow up on the status of the claim and get them to expedite processing. The status of the claim is tracked in the our software platform by assigning the claim to the appropriate appeal processor, and setting an automatic follow up date to the file.
Claims which are pending submission of medical records (records requests) will be listed as pending in the billing platform until the matter is resolved. The records sent within one week and will require certified mail. All tracking info is included in our files as an upload with an automatic prompt. Sent records will be followed up 3 days after they are delivered to get a recorded acknowledgement of the receipt, and the file in our software will be updated with the call number and date.
Each request is noted in our software and the monthly A/R report will note any past due claims which require action.