Correspondence Follow up and Denial management
In cases where charges are denied, or in cases where payments and contractual allowances do not conform to payor fee schedules, the charge status is changed from insurance billed to insurance denied.
Denied charges are categorized by type, assigned to task lists, and addressed by the Insurance Follow-Up team.
The Insurance Follow-Up team involves other team members with requisite subject matter expertise for assistance in resolving denials relating to enrollment, documentation, coding, and other complex matters.
Denied charges are monitored by the Insurance Follow-Up Manager and escalated to clients where necessary and appropriate.
When all other appropriate follow-up and recovery efforts have been exhausted, denied charges which are deemed non-recoverable are recommended for write-off.
The write-off reason is annotated in the System and the charge status is changed from insurance denied to insurance write-off requested.
Claims which remain unpaid after pre-determined, payor-specific timeframes are flagged by the system and populated to task lists for further review.
Members of the Insurance Follow-Up team use payor web portals and phone inquiry lines to investigate and annotate claim status.
Overall aging of the accounts receivable portfolio and associated trends and issues is monitored by the Client Service Executive and discussed with clients on a regular basis.