Rejected Claims Processing, Follow-Up
Claims that are rejected or returned by insurance companies are immediately reprocessed. Our billing software instantly receives rejected and returned claims and prompts our Billing Department to analyze the claims and prepares them for resubmission.
Claims that are not paid for more than 60 days after submission are transferred to our Follow-Up Department for further inquiry. The Follow-Up Department ensures that every line of service on every claim is reimbursed. Follow-Up specialists are trained to investigate carriers’ reports, determine why the service(s) is not paid and take the actions necessary to receive payment. Follow-up is a standard process we use to resolve insurance denials of claims based on reasons such as: "there is no claim on file with insurance company" (we re-submit immediately with proof of timely original submission); "additional information is required to process this claim," such as medical records or assignment of benefits (we contact your office for this information and forward it to carrier in timely fashion); "insurance is terminated or another insurance is on carrier’s files" (we contact your front desk and, if needed, your patient to obtain correct insurance information and resubmit accordingly).
In some cases, claims are denied based on patient responsibility (i.e. patient deductible, lapse in insurance coverage, etc.). In such cases, following review by your office, patients are billed directly. To the extent that payment cannot be obtained through the process of direct patient billing, at your discretion unpaid claims may be sent to a collection agency.