3 explanations why your claims aren’t getting processed

Why This Topic Matters

Understanding the sources of claim delays helps practices interpret missing or late payments, anticipate processing bottlenecks, and follow industry updates from payers, clearinghouses, and CMS.

Article Sections

1. Physician payments

   Introduces the payment disruption context and identifies the industry transition associated with the claims-processing problems. It also frames the issue from the perspective of practices receiving delayed or missing payments.

2. Behind the scenes: what happens after claims leave your hands

   Explains the general path claims follow through clearinghouses and payers and summarizes broad categories of operational breakdowns affecting processing. It also references the organizations and intermediaries involved in the disruption.

3. 1. Your payer botched 5010 testing

   Describes a payer-side testing and production mismatch affecting claims processing during the transition period. The section focuses on system readiness and live-claim handling at a high level.

4. 2. Payers reject thousands of claims for a single erroneous claim

   Covers file-level claim rejections and the downstream impact on clearinghouse resubmission workflows. It also notes a comparison to earlier claim-format processing and references CMS commentary.

5. 3. Clearinghouses aren’t getting error reports from payers

   Discusses delays in error reporting and how that affects clearinghouse follow-up and claim-status visibility. The section focuses on timing and communication gaps in the claims process.

6. Some good news

   Summarizes the article’s closing update on the apparent improvement in the disruption trend and the general expectation for normalization. It also includes CMS’s reassurance about claim status timing.