When the denials can be fixed and refilled the most worrisome part for all offices is the claims with no response. Most billers do not go thu these claims as they are busy entering new claims and posting the payments received and last working on the denials. It is found that many practices lose millions in the denied and no response claims every year. The managed care contract allows 30 days for the insurance companies to respond to you without any interest or penalty.
The biggest problem here is that most no response claims are not on file with the insurance. These claims are sent but for some unknown reason they do not receive it or process it.
ZenMed has the most efficient approach in following-up on these. We have a dedicated team who works just on these claims. We run a unpaid claims report every 30 days for claims sitting without payment for more than 30 days in the system from the filed date.
This way we not only track the no response claims but also see to it that the denied claims addressed are processed and paid. We also follow up on all appeals sent.
When we get to know a claim is not received by the insurance we find out alternate way to get it to the payer by either faxing it to them or sending a paper claim. If for any reason a claim is denied and we never received a EOB we take necessary steps for it to be corrected and filed. If for some reason the claim gets denied requesting information from patient, we let the patient know. If we are not able to reach the patient for any reason we let your office know so that they tell the patient the next time they come in to see you.
Old AR follow-up
We also make an efficient plan to get your old claims paid. There is a different approach we take on these claims as the time we have to address these is comparative lesser to the current claims.
- We sort the outstanding payer wise so that we can concentrate first on the payers with lesser filing limits.
- We sort the outstanding balance wise so that we can get to the big ticket items first to minimize the loss.
- Then we get to clean up those that are low dollar and higher filing limits.
This is the most proven model in the industry. Our reports that we send you every month will tell you how good we are.