Claim status calling process

Calling Insurance for claim status

How to call for claim status

A/R callers either take status from IVR or from Insurnace representative , for both IVR or respresentative, A/r caller need to provide below things in order to verify him.

1. Provider name
2. provider ID
3. provider tax id
4. provider NPI

Then you will be able to take claim status and for that you need

1. Patient id #,
2. Patient Name
3. Date of Birth
4. Date of Service
5. Billed amnount on claim

Then representative will let you know

Claim would either not on file, in process, approved to pay , Paid or Denied

If it is paid, You will come to know

1. Allowed amount
2. Patient Responsibility
3. Paid Amount
4. Check Number
5. Check Date

and if there is any Denial, then it will let you know denial reason.

If its not on file, you need to check wheather the claim is submitted or not, and if yes, do check mailing address.

If its in process, then you can ask process days and wait for the process to complete

If its approve for payment, you can payment details.

Accounts Recievable management Process

Management of Accounts recievable in medical billing is responsible to maximize the collections and brining down the accounts recievable , it monitors all the activity related to accounts recievable in such a way to maximize the collection which is a core objective for any billing company.

For the above responsibilities, medical billing company have A/R analyst.

Responsibility of A/R analyst:

- maximize the collection
- Bringing Down the Acconts Recievable
- Reporting related to Accounts Recievable
- meet the Accounts recievable targets
- Keeping track of Electronic and paper Claims
- keeping track of rejection and denials so that further action can be taken on them.
- Keep himself and other departments updated with latest updates in billing
- Cordinate with call center agents (Follow up department) to get the issues solved

In order to bringing down the recivables, get the outstanding claims to be processed completely and for that , one should know about the outstanding claims.

- Claim not in System
- Claim pending
- Claim is in Process
- Claim denied

Claim not in system:

Claim not in system means that claim is not yet recieved by insurance , it can be because of many reason, either The mailing address or information on claim is not correct or the claim is in transit.

Claim pending:

It means that insurance have recieved claim but it is pending because of the information required from provider or patient.

Claim is in process:

it means insurance have recieved claim but it is in process as it take few days to process and the processing time of insurance is different to each other which we will also discuss in next article

Claim denied:

Claim is denied because of defined rules and regulation are not followed , insurance processed them and send EOB which will explain the denial reason.

Medical Billing Process summary
Charge Entry Process
Payment Posting Process
What is EOB (Explaination of Benefit)

Charge Entry Process in Medical Billing

Summary: This article would help you to understand the required field and procedure of Charge entry:

The document which used for charge entry process is Super-Bill which give basic information of ICD and CPT codes required for Charge Entry.

Fields which required in Charge Entry

1: Patient Account No. (Which is assigned to patient at the time of registration)
2: Facility ID or Hospital ID
3: Doctor ID or Provider ID
4: PCP ID - optional
5: POS (place of service)
6: DOS (Date of service)
7: Member ID
8: Dignostic Codes (ICD codes)
9: Procedure codes (CPT Codes)
10: Modifiers
11: Units
12: Billed Amount - (Billed amount is entered against every procedure code).

Enter all above fields in a claim and amount against every procedure codes and make sure that the tree created between ICD and CPT codes should be correct and enter modifier with procedure code when it is required.

Above were the steps and field involved in charge entry process and claim creation
More Information:
understand the process of Patient Demographic
Complete Medical Billing process

Steps Involved in Medical Billing and Coding Cycle

Below are the medical Billing and coding steps and every step have its own importance which cant be neglect and Quality assurance should involve in each step.

steps involved in medical billing:

- Entry of patient Demographics
- Medical Coding
- medical Billing
- Charge Entry
- Claim submission to insurance
- Payments Posting
- Accounts recievable Management and follow-up
- Denial Management
- Management Reporting

Medical Demographic Entry process in outsourcing companies

Medical Demographic Entry process in Outsourcing Industry

Demographic Entry capabilities includes:

• Ability to work off scanned images as well as Electronically Submitted Demographic Entry Sheets
• Ability to correctly process insurance Information (selecting appropriate PO Box etc) as necessary including HMOs, PPOs, IPAs

Demographic Entry process steps include:

1: Demographic information scanned and send through email, fax or directly copy on servers
2: Information then directly entered into software.
3: Internal Quality Assurance performed at three different levels:

- Individual
- Team
- Independent Audit Team