Are you having trouble getting paid? Is insurance holding onto your money? Are you tired of being given the run-around just to get paid what is owed to you? If so, then we can definitely help!
It is guaranteed that every provider at some point will have to deal with a particular patient account where insurance is refusing to pay. Sometimes it can be due to legitimate reasons, like a prior authorization was not filed, or the provider rendered services to a patient before checking whether or not that patient was covered. However, many times the reasons are not legitimate, and there is some disconnect in the payer’s system that is causing a particular patient’s claims to get hung up in a never-ending cycle of constant resubmission and rejection.
Many insurance companies purposefully setup their claims department to where the customer service reps are not allowed to directly contact the claim adjudicators (i.e. the people who process the claims). They set up this wall of separation as a roadblock to prevent angry providers from constantly calling in to find out why their claims are not getting paid.
When providers call in to follow up a particular issue, the rep usually tells them that they will send their claims back for reprocessing, and to give them 7-10 business days. Then when the provider does another claim status a couple of weeks later, they see that their claims still rejected. So the provider calls the insurance company back, gets a different rep on the phone who they have to explain the entire issue to for the 5th time, only to be told that the claims will have to be sent back for reprocessing again… and so the cycle continues.
As you can see, we’ve been down this road many times, and we know exactly how to bypass this roadblock to make sure we get the right person on the phone, and get you paid.
The following items below would be covered under our Accounts Receivable Recovery service:
- Take ownership of any outstanding claim balances that have not been processed by insurance and see what can be done to facilitate payment.
- Determine the appeals process and submit the necessary information for any claims that the provider wants to challenge.