Insurance Follow-up
November 2023
Following up on outstanding open claims can be a daunting task – navigating dozens of online payer portals and waiting endlessly on hold for a representative. Add that to your existing list of daily responsibilities and insurance follow-up can easily make even a seasoned biller feel overwhelmed. But, fear not. We have 3 steps to make it manageable: 1) Identify Follow-up; 2) Set a goal; 3) Make a plan.
Identify Follow-up
Claim processing typically takes between 30-45 days. Some claims will require additional information to process and may take longer. Coordination of benefits, where services rendered are sent to multiple payers in sequence, will also extend this timeline. It helps to define what your practice considers outstanding and then set your follow-up parameters accordingly. Generally, we use the following to identify outstanding claims that need follow-up:
Open claims that have aged 45 days or more
Claims that are requesting additional information
Claims that adjudicated but do not produce a “clean” EOB (claim paid according to allowable or contractual fee schedule for services
(Read our blog on the 5 Stages of Claim Processing for more information on adjudication.)
Set a Goal
Once you know how many accounts need follow-up this month, it’s time to create a goal. Why do you need a follow-up goal? Well, goals are necessary for keeping things on track, keeping your AR healthy, and keeping cashflow consistent.
How many follow-up accounts do you have?
How many days this month can you commit to follow-up?
Make a Plan
Now that you have a daily/weekly goal for the number of follow-ups you can make a plan. Look at your follow-up accounts and group them by payer. Which can be followed up together on one call? Which can be looked up online while you are doing other tasks (sitting on hold for example)?
A good strategy will make follow-up less overwhelming and will incorporate follow-up seamlessly into your daily work rather than letting it pile up.
Do the math. Set a goal. Review your schedule. Make a plan.
Dental Billing & Consulting Professionals offers a 1-hour virtual training on setting goals for insurance follow-up. Call or text us any time at (860) 435-7344 to learn more!