Rejections & Denials are handled by AR-Analyst (they forward the denials to the specific department for the correction and to re-bill the claim to insurance company). If the reason of denial can’t be found or there is delay in the payment then Analyst forwards the claims for A/R follow up to get the status of the claim.
A/R department will follow up with the Insurance to get the claim status and collect the payment from the insurance company.
If error has been found at the beneficiary end (patient has provided wrong insurance details, incorrect home address, wrong employer information, etc.) then A/R dept needs to follow up with the patient (as per physician’s permission).
Once A/R dept is not able to collect the money then they send 3 warning letters to the patient within 90 days. If patient is not responding, give it to the Collection Agency for the collection of payments.
Finally amount goes to the Physician with the detail report of total billed and collected amount in the month.
INSURANCE CLAIMS ANALYSISPATIENT FINANCIAL ANALYSISA/R FOLLOW UP PROCESSA/R REPORTS