REIMBURSEMENT: 7 Tips Help You Avoid Computer Claim Casualties

Why This Topic Matters

Processing glitches can create delayed payment, denials, or incomplete claim handling that may go unnoticed without active follow-up. The article is relevant to organizations that need to protect cash flow and verify whether claims were received, processed, reprocessed, or improperly adjusted.

Article Sections

1. Monitoring EOBs and Accounts Receivable

   This section discusses routine review points used to detect payment problems and claim processing irregularities. It emphasizes tracking claim outcomes and unpaid balances at a broad operational level.

2. Following Up with MACs and Payers

   This section covers communication with Medicare Administrative Contractors and other payers after a suspected processing problem. It focuses on confirming whether claims were received and whether follow-up actions have occurred.

3. Using Timelines and Resubmission Checks

   This section addresses the importance of timing when claims are transmitted, received, or returned for further handling. It also covers reviewing whether a resubmitted claim may encounter another processing delay.

4. Carrier Websites and CMS Regional Offices

   This section describes using online payer resources and, when needed, contacting CMS regional offices for unresolved claim handling concerns. It highlights escalation pathways outside routine billing follow-up.

5. Communication Approach

   This section focuses on maintaining persistent and organized communication when working through claim issues. It emphasizes obtaining complete information before ending a payer conversation.