Account receivable follow-up

Our A/R Follow-Up service is designed to increase Revenue Collection for Physician offices. The process begins after the Doctor's biller creates and sends Health Insurance Claims (Electronic/ Paper claims or Manual HCFA forms) to various Insurance companies. Depending on the transmission type and length of time since submission we begin our follow-up:

Electronic Claims: Follow-Up begins 10+ days after submission
Paper/HCFA Claims: Follow-Up begins 20-45 days after submission

There are two types of claims Follow-Up:

  • No remark claims: Any claims in which absolutely no status is known for the claim.
  • Last remark claims: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons for rejections include:
    • Authorization Issues
    • Referral Issues
    • Medical Necessity and Medical Records requests
    • Non-Participation with Insurance Network
    • Terminated Insurance
    • Coordination of benefits
    • Wrong Diagnosis
    • Inclusive Procedures
    • Partial Payments
    • Out-of-network claim status and deductibles
    • EDI Rejections
    • Letter of Protection from Attorney cases
    • No status and No claim on File
    • Workers' Compensation
    • PIP cases

The Follow-Up process is divided into 3 methods:

  • Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.
  • Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.
  • Insurance Company Representative Call– If necessary, calling on telephone an Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.

Once the Follow-Up process has begun Denied Insurance claims will require extra effort for resolution. Denials management is divided into two categories:

  • Claim Correction and Resubmission: These are the claims which are corrected, modified, and resubmitted as a corrected claim to Insurance companies. For such claims every effort is made to resolve the denial to avoid billing the Patient.
  • Patients' responsibility: These are claims which cannot be further worked upon and the final bill is sent to the patient for payment collection. The reasons for sending the patient a bill generally include In-Network deductibles and non-covered benefits as per the insurance plan/policy. Patients will receive a statement with a clear explanation for the balance due.