Dr. Sedra, thank you for providing us with this opportunity to trust our team (Syed) and we appreciate you giving us the chance to resolve your clinic’s unpaid claims, some of which are already several months old.
Syed reviewed every unclosed claim and worked those still collectible and traced each denial back to its origin.
What we couldn't fix was time. Some payers allow only 90 days to file a claim, and a rejected claim doesn't count as filed. A number of these had gone round a reject, correct, resubmit loop for months with no proof on record that they were filed on time. Once that window closes, even a strong appeal rarely pays.
I particularly recommend that you follow the protocol left by Syed:
- Scan the insurance card, front and back, at every visit. The front gives the member ID; the back shows the claims processor; a new card can flag a plan change before the claim is submitted.
- Verify eligibility on primary and secondary insurance before patient is seen.
- Inquire about other coverage for all patients, such as through a spouse or parent.
- Work rejections within days, not at end of the month and maintain a copy of the payer's acknowledgement report to indicate claims were filed on time.
It was perfect to hear you now verify eligibility the night before each visit. That one step will eliminate a huge portion of the denials we uncovered.
It was a real pleasure getting to know you and your practice. You know where we are if you ever need anything, just a call or text away.
Raief
Director, Quilven