MedicalMedical Claims Statusing
A SelectSmart.com Flowchart by amarin
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A guide to statusing and following-up on out-of-network medical insurance claims Anesthesia- Pain Management

                 
Claim Denied
YES
Get specific info, why claim denied is there specific info that can be submitted to have claim re-reviewed/reproc? If so, -document in computer
YES
Get submittal info -fax # -ref# -claim# -specific documents to submit -document in computer
 
 

NO








Do we have any pmt info in termlite or do we have accurate pmt info in the computer?
NO
Find out where pmt is Did pt rcve check?
YES
find out if check has been cashed, the exact dollar amt of check, what day the check was cashed and document all information in the computer -call pt and send stmt with notes of pmt being due asap
 
 

YES


NO






Does pmt info meet the criteria to be adj, or billed to pt?
Was the check mailed to wrong provider address or another provider entirely?
 
 
 

YES


YES






Follow appropriate next step of either sending pt a stmt or requesting acct be adj -document in computer
if so and there is no record of pmt in termlite,request a front and back copy of the check to be sent to office for pmt trace (preferably have them fax instead of mail)