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Following up on unpaid claims is an important part of the collection process. However, if it is done in the wrong way, it can result in loss of revenue. The only solution to the problem is to analyze your collection process for inefficiencies or missed opportunities. The more you keep analyzing your process, the greater are chances of denials and rejection, which in turn maximizes revenue.

When following up on claims, there are certain things to be considered:

Are Your Claims Being Received by the Insurance Provider?

This problem occurs the most with paper claims. So, filing claims electronically can help resolve the issue.

Are Claims Being Denied or Rejected?
It is extremely important to identify the reasons behind claim denial or rejection. Claims that are rejected can certainly be fixed whereas denied claims should be appealed and take longer to process again.

Claim rejections occur when claims do not meet specific data requirements or basic formatting as designed by a set of guidelines in Centers for Medicare and Medicaid Services. If the payer did not receive claims, they can’t be processed. Rejected claims can be resubmitted once the errors are fixed.

Denied claims are an entirely different issue. They are defined as claims that were received and processed by the payer, however, a negative determination was made. This kind of claim cannot be resubmitted. A research should be done to identify why the claim was denied. This helps in writing an appropriate appeal or reconsideration request.

Are You Tracking Outstanding Collection?
Proper tracking can help identify issues quickly and following up on them help in addressing correctly and timely. It is important to track and analyze trends in payer denials and work to those issues to fix them as quickly and efficiently as possible.

So, if you are not proactive about why a claim was denied or rejected could seriously impact your practice’s revenue. Therefore, we constantly encourage practices to follow a thorough process towards claim management. Our trained staff works on immediate appeal of all denied claims and closure of all paid claims. With our trained staff in insurance verification and charge entry, we minimize denials.

We understand that denials are a universal problem for providers across the world. At Capline Dental Services, our billing experts can resolve appeals and denials. Additionally, we also provide reporting. So, you have less headache with maximized cash flow. Give us a call today if you have any questions about improving your follow-up process.