How to hunt down lost paper claims

Tips for speeding collection of overdue claims

About 80% of Medicare claims are submitted electronically. An all-too-common problem for the other 20% of paper-based bills is having the carrier lose or misfile a claim. As a rule, carriers generally hold clean paper claims at least 26 days before paying. Here are some tips on speeding up payment for paper claims still outstanding after 30 days.

Most Medicare carriers have an Automated Response Unit (ARU) line to help you determine the payment status of a particular claim. To make most efficient use of the ARU system, you should have the this information at hand when you call: Medicare provider identification number, your patient’s health insurance claim number, the date of service, plus any other pertinent information.

If the carrier says it has no record of receiving such a claim, all you can do is resubmit it as a new claim. And while you have the carrier on the line, it is a good idea to double-check the mailing address — including the post office box number and extended zip code — against the one on your claim.

If the ARU operator says the unit’s records show the claim has been paid, make sure you get the following data for your files: the pro vider remittance notice number, the paid amount, and the date the carrier says it paid the claim. How ever, if you still have not received payment after allowing adequate time for the check to arrive in the mail, call the carrier again and ask for a copy of the remittance advice. If the carrier says the check has been sent and cashed, ask for a copy of the canceled check.

Handling pending claims

More than likely, rather than saying the ARU did not receive the claims, the ARU representative will tell you the claim in question has been held up pending a review because of a question regarding the coding, the amount, or eligibility requirements.

Find out as much as you can about what in the claim has been questioned and when the review may be finished. Make a note of the date, time, and to whom you spoke. Also make sure the billing and collection department gets a copy of your notes and the patient’s financial records are updated.

Many experts suggest it is probably best to simply do nothing if the carrier is performing an eligibility or nurse review until the review is done and a decision made to either pay or deny it.

If the reviewer wants more data before making a final decision, you will receive a letter asking for additional information. Remember: It is in your best interest to respond immediately to that request because the carrier is going to hold the claim until it receives the information it requested. The carrier also may reject the claim if it feels you did not respond in a timely manner.