Health care claims process involves different types of billing methods. It normally takes 15 days for receiving payment; if your insurance payments average a TAT of more than 30 days from sending the bill, you need to develop a claim follow-up process.
How the Medical Insurance Company Works
Most of the managed care contracts allow insurance companies to take 30 days time for responding to claims without interest penalty. They may take longer for paying too. It is essential to develop effective collections policy for medical care claims to guarantee quick payment. Practice accounts receivable days can be certainly improved by following up on the status of health care claims.
Reasons that Necessitate Claims Follow-up
Depending on the billing method, health care claims may be paid between 15 and 30 days normally. It is not required that insurance carriers must pay up within this time frame though. Following are the major four reasons why medical claims have to be followed up:
Claim not received at all
o One of the primary reasons for non-payment is the claim never being received – this mainly happens when paper claims are missed or lost mysteriously. Sending electronic claims is the best remedy to counter this problem. Checking whether the claim has been received properly and if not, taking action to send out another claim sooner is essential.
o By calling the insurance providers, you will be able to understand the reasons for denial even before collecting the paper denial through mail. Resubmitting the claim after correcting the relevant factors shortens the TAT for payment
Claims Put on Hold for want of Information
o In case additional information is required from the patient, health care claims may sometime be kept aside for further data. Patients will be intimated by insurance companies to this effect, yet, it is better for collectors to keep in touch with patients so that unwanted delay may be avoided
Underpayment / Lower Reimbursement than Contracted fee schedule
o In the event of the insurance company paying a claim, but the amount is found to be lower than the contracted fee schedule, the issue needs special attention – revising billed amount for achieving maximum value on contracted payments need to be done
Numinatrans is equipped with a team of billing experts who are capable of analyzing reasons for claim denial, tracking common denominators, and identifying and eliminating the weak links. We ensure that our denial management support and collections service help reduce delayed and rejected claims considerably.
For further details, visit our website www.numinatrans.com