Medical Billing and Coding: Following up On an Insurance Claim

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Posted on 16th December 2010 by admin in Uncategorized

Considering the large number of claims that are filed with insurance companies by medical practices or healthcare facilities every day, it is important that medical insurance specialists are able to keep track of the status of each claim that they submit.

Ideally, an insurer will respond within 14 days from the date that the claim is filed.  The medical insurance specialist should allow this 14 day window before calling the insurer for status of the claim.  On the 15th day, if there is no response from the insurer, the medical insurance specialist should call the insurer to verify claim was received and what stage of the process it is in.

Medical insurance specialists can benefit greatly by learning and becoming familiar with the insurer’s policies and schedules for processing claims.  By understanding the process, its stages, and requirements medical insurance specialists are able to learn shortcuts through the system that can help them to speed up the reimbursement time.

A remittance advice is the summary of the claims submitted by the healthcare provider to the insurer.  The remittance advice summarizes the claims into groups by healthcare provider.  Several patient claims can be listed for a single healthcare provider.  This can be confusing especially when reimbursements are lumped together into one check.  Each remittance advice should be carefully looked over and compared with the claims submitted by the healthcare provider to the insurer.

An explanation for each claim will appear on the remittance advice summary.  Explanations are made for every partially reimbursed or denied claim.

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