Claims Paid Unreported/Not Posted

Purpose

To ensure the proper procedure is utilized when identifying an outstanding claim amount to have been paid by the insurance company but not posted or reported by the clinic.

Policy

At the time that a payment has been identified to have been made by the insurance but not posted to a claim, the A/R representative will use all available resources to obtain the Explanation of Benefits (EOB) for posting including:

  • payer websites
  • fax request
  • mailing request

The RCM team will use the Claims Paid task function to alert the client to the information and request they report the EOB in a deposit. If Client fails to provide it within the 30-day timeframe, Clinicient will complete the task and the payment information will be recorded on a spreadsheet and sent over to the payment posting team for posting.

 

Clinicient (the “Company”) is providing this information for general guidance. The application, impact and change of laws can vary widely. Accordingly, the information is provided with the understanding that it is not offered as legal or any other professional advice or services and as such should not be used as a substitute for consultation with professional and licensed advisers. While we have made every attempt to ensure that the information contained herein is accurate at the published time, the Company is not responsible for any errors or omissions, or for the results obtained from the use of this information. All information is provided "as is," with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use of this information, and without warranty of any kind, express or implied, including, but not limited to warranties of performance and fitness for a particular purpose. In no event will the Company or its subsidiaries, agents or employees thereof be liable to you or anyone else for any decision made or action taken in reliance on the information.

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