- Constantly keep tracking both Electronic and Paper claims to avoid any rejections or untimely filing
- Enquire status on unpaid claims via online tools or Fax request to the carriers
- Examines ERAs/EOBs for carrier denials and under payment
- Identify claims for appeal and re submission and initiate the appeals.
- Forward denied claims with analysis reports, to the appropriate departments for corrective actions and
- Ensure A/R days meets industry standards
- Reporting as per clients requirement
Our dedicated and highly skilled AR Insurance telephone crews aggressively follows up on status of claims with various insurance companies, request clarification on billing and reimbursement procedure, and act on work orders issued by various departments needing carrier assistant via IVR and Phone. The A/R follow-up department starts chasing the electronic claims after 15 days from the date of transmission and paper claims after 30 days from the date of dispatch just to avoid untimely filing.
Our A/R Follow-up department helps to obtain the status of unpaid claims, denial and reasons with actions required and status of appeals. Any incorrect denials are explained to the insurance rep during the live call and incorrectly denied claims are sent for reprocessing.
Healthcare providers loose a lot of dollars due to a lack of follow-up on out standing claims with the insurance companies. A/R follow-up team at BlissMD ensures every penny submitted is collected in a timely fashion. Any claims that need to be appealed or pending for additional information are escalated to the respective department to fix it. Our each team of analysts is fully informed on constantly changing billing rules and situations pertaining to specific geographic areas to stay compliance.
Some Routine Issues Fixed Often by A/R Follow-Up team are:
- Authorization and Referral issues
- Medical necessity and Medical record request
- Network Non-participation issues
- Incorrect/Invalid Diagnosis code
- Bundled procedure
- Coordination of benefits
- Partial payments / underpayments
- Claim not found
- Member not found
- Terminated coverage
- Other Insurance Primary
- Out of area claim
- Workers Comp
- Reprocessing Incorrect denials by Insurance on live call with the representatives
- Claims pending for additional information From provider/patient
- Incorrect check mailing address
- Refund Request
- Patient statement queries