Every aspect of the Revenue Cycle Management (RCM) involves process and Claims Management is no exception.  Managing revenue cycle requires constant attention to detail. Submitting claims is only the first step.

Following up on unpaid claims is necessary even with a completed Triple Check.

• Be aware of human error, double check your work prior to submitting claims.
• Check your billing software to determine the configuration and setup to help you manage the claims process.  This should be checked on a daily basis for claims processing.
• Does the insurance carrier have a web portal that you can access to check the status of claims?  This is the most time efficient way of verifying status and provides the most amount of detailed information. It allows the denial management process to be handled quicker than waiting for an Explanation of Benefits.
• Be diligent once claims show having been received.  Follow up within 10 days and continue to follow-up every 7 days to ensure prompt and effective payment.
• Call the provider line for the specific insurance company.  Some Insurance companies use IVR for claim submission information when you provide the insurance id and denial or payment information.  Once you speak with a representative, document the representative’s name and detailed information including a reference number for verification of phone call.  These calls are recorded.
• Develop a follow-up system in order to make sure nothing gets lost in the shuffle. Use a tickler file, Outlook, or your database management system.
• Do you have a copy of the carrier contract?  This will ensure that you use a reference with the insurance company if the claim is not being paid at the correct rate.
• It is best to be assertive when following up on claims since Insurance companies use stall tactics to prolong the payment. Education and information and being proactive are key in claims management.
• All claims need a follow-up; having a Triple Check completed doesn’t ensure the claim will get paid.
• Claim never received- when sending paper claims.  Send electronic for quicker and more efficient submission
• Follow up should be immediate for electronically billed claims within the software.
• Depending on the denial reason, be diligent and have documentation ready, for example, w9 or medical records.  Anticipate any obstacles to payment.
• Manage denials and identify trends that reflect process that can be corrected in the future             

Most commercial insurance companies have timely filing guidelines and submission limitations, starting with 90 days to 365 days.  Time is of the essence!

Commercial claims follow-up is a critical step of the Revenue Cycle Management process. By following the steps above, the process can work for you and help to minimize any risk for denials, rejections, and non-payment issues.