We clearly understand account receivable is the vital part of any business. Our experienced billers use various follow-up methodologies to ensure prompt payment. We keep a good track of outstanding accounts and follow-up on time providing maximized revenues.
There are two types of claims Follow-Up:
- No Response Claims: Any claims in which absolutely no status is known for the claim.
- Unpaid claims: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons includes:
- Authorization Issues
- Referral Issues
- Medical Necessity and Medical Records requests
- Non-Participation with Insurance Network
- Terminated Insurance
- Coordination of benefits
- Wrong Diagnosis
- Inclusive Procedures
- Partial Payments
- Out-of-network claim status and deductibles
- EDI Rejections
- Letter of Protection from Attorney cases
- No status and No claim on File
- Workers' Compensation
- PIP cases
The Follow-Up process is divided into 3 methods:
- Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.
- Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.
- Insurance Company Representative – If necessary calling a "live" Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.
Apart from normal follow up, we implement a unique strategy plan for follow up claims based on priority:
Priority 1 - High Dollar High Age - These claims would be processed on priority as the claims need to be followed up before we exceed the filing limit.
Priority 2 - High dollar Low Age - Next focus would be on high dollar claims with low age as the chances of collection are higher.
Priority 3 - Low Dollar Low Age - These claims have higher probability of collection. However, need many more resources to follow-up.
Priority 4 - Low dollar High Age - These claims are given last priority as these claims have less chances of collection and need high number of resources to follow-up.