Whether your medical claims are billed electronically or paper billed by mail, it is imperative that your medical office staff follow-up with the insurance carriers to obtain claim status.
Once the bill has been received by the insurance company, you do not have to be at their mercy to get paid in a timely manner.
Depending on your billing method, you should expect to receive payment in as little as 15 days. If your insurance payments are averaging a turnaround time longer than 30 days from the time your bills are sent out until you receive payment, your office needs to develop a process for claim follow-up. Following up on the status of your claims can definitely improve your accounts receivable days.
Most managed care contracts allow insurance carriers 30 to respond to your claim without penalty of interest. That doesn't mean they have to pay the claim within this time frame. Developing a collections policy for your medical claims can guarantee that your claims will be paid quickly. There are three reasons why you need to follow-up on your medical claims.
The claim was never received.
The biggest delay in payment is due to the claim not being on file. In other words, the claim was not received. This usually happens mostly with paper claims getting mysteriously lost. To avoid this, it is wise to send claims electronic when you can.
If the claim hasn't been followed-up on quickly, it could be a month or longer before you would even know the insurance company hasn't received the claim. For paper claims, allow 10 business days before calling to see if the claim has been received. For electronically billed claims, you should be able to call within 5 business days.
The sooner you are aware that the claim has not been received, the sooner you can get another claim out the door.
The claim has been denied.
Depending on the denial reason, you can have the new claim sent out way before you even get the paper denial through the mail. By calling the insurance company and finding out the denial reason instead of waiting to receive the denial in the mail, you can possibly correct the reason the claim was denied. Resubmitting the claim days up to 7 days earlier than waiting for the denial in the mail will definitely shorten the turn around time for your payment.
The bottom line is getting a head start on your denials to get the claims process moving again.
The claim is pending for information from the member.
Sometimes claims can be placed in pending for a certain amount of time due to additional information needed from the member. Although, the insurer has probably sent the patient a letter in the mail, it would be wise for your collectors to contact him or her as well.
One reason is that by calling the insurance, you can notify the patient before the letter ever reaches them. Also, if you can get them on the phone, you can hold a conference call with the member and insurer to make sure the information is given and received.