Author Topic: Claim Status - How much is enough?  (Read 1030 times)

williamportor

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Claim Status - How much is enough?
« on: May 03, 2014, 08:16:50 AM »
Hello- As a medical biller I'm wondering how much claim status information my Doctor/customers need. In checking claim status every few days, I often find I can resubmit denied claims quickly and get them paid faster, and/or report to my clients what the problem is, so they can take corrective action if necessary.  I'm finding sites like availity.com are only about 20% reliable, so I'm spending almost as much time on the phone with insurance companies checking claim status as I do billing. Is all this claim status inquiry really necessary? If so, how often should a biller need to check claim status? Or...should they simply wait for the payment and EOB's to arrive before following up?

PMRNC

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Re: Claim Status - How much is enough?
« Reply #1 on: May 03, 2014, 09:48:53 AM »
Here's what I do, I run an aging report by carrier, I determine an average time for each carrier. Anything above that and I make a call. I too do NOT like online eligibility or status, I find it much faster and more effective to call. If you schedule your time efficiently you can get er done.  If you do it this way you can check status of claims by carrier which will save you some time.
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kristin

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Re: Claim Status - How much is enough?
« Reply #2 on: May 03, 2014, 04:32:00 PM »
I run an AR at the end of every month, and follow up with any claim that is over 30 days. Most payers pay clean claims within 10-21 days, and if it hits 31 days, I know something is potentially wrong.

As EOB's come in during the month, and if something should deny, I follow those denials up immediately, same day or next day at the latest.

I don't ever "routinely" check claim status, though, like you mention doing. So long as my clearinghouse reports show that the claim was accepted for processing, that is good enough for me until a denial comes or no response after 31 days happens.