Going through your AR (accounts receivables) can be very tedious. It is time to
call the insurance company when your claims has not been paid. I would
recommend to call the insurance company after 2 weeks if you submit your claims
by electronic submission and if it says on your transaction report that the claim
went through by electronic without any problem. Now, if you submit claims by
paper claims, it may take 30 days for you to pick up that phone and call for follow
up if it has not been paid.
When calling the insurance company for follow up, you will be asked for the
following information:(make sure you have them ready before you make that
phone call).
1. Provider's Tax ID number and NPI Number (rendering provider or group NPI)
2. PTAIN (Provider Transaction Account Number) - you need this for Medicare
beneficiaries. This is actually what they call the "legacy number".
3. Patient's Name and Date of Birth
4. Patient's Insurance ID Number
5. Date of Service
6. Total Charge
7. Procedure rendered (sometimes they will ask you what procedural code is on
the claim)
If the status of the claim is: PAID.
Obtain the following information.
1. Date it was processed
2. Allowed amount
3. Patient's responsibility
4. Amount of the check
5. Date of the check
6. Check payee
7. Document the phone call (customer service rep's name, reference number,
date and time you called!)
If the status of the claim is: Denied and Rejected.
1. Get more information the reason of the denial
2. Get the reference number/claim number and customer service representative's
name
3. Request for their policies and guidelines
4. Appeal the claim
*** if they still deny it, it is helpful to have the patient get involved with the claim.
5. Document the phone call (reference#, date and time you called!)
If the status of the claim is: In Process
1. Document the phone call (customer service rep's name, reference number,
date and time you called!) - if you don't see payment in 14 days, call again!
Before you call or check the status of your claims, make sure your EOBs posting
are up to date. You can either call the insurance company or if you have an
access on their website, you can also check the status of the claims online.
Check with your payors. I know that some insurance companies provider limited
access for those who are non-participating providers.
Do not allow any of your claims simply gets dropped without payment. You are
obviously losing money here.
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