Looking for a team to help you directly with your problem claims?  Contact us directly to learn more about our mental health billing service.

Fixing Your Claims

Incorrect claims floating in the insurance maze is all too common.  This article’s goal is to help you follow a series of steps to fix your problem claims.

All of these fixes will require your time and energy.

Step 1:  Learning Where Your Claims Go

You must call the phone number on the back of the patient’s insurance card and get to a representative.  For tips on how, check our article here.

Ask the representative if the patient’s coverage is active.  Then ask if you are in-network and eligible for services.  This helps you make sure you are able to be paid in the first place.

Then ask where the claims are to be submitted and write that information down.  If you use an electronic clearing house, make sure to ask for the payer ID.

Step 2:  Verify Claims Receipt

Submit your claims.  If you are submitting paper claims, wait appropriately 30 days to call and verify receipt of the claims.  If you filed them electronically wait 10 days.

Wait the appropriate amount of time and then call and verify the claims are received.  Ask “are my claims on file?”

If no, verify the claims address and payer ID.

Ask: “does this plan have a mental health claims address, payer ID?  Is this policy subcontracted or carved out?”

If they tell you there is a different mental health claims address, file there.

If they are not on file, ask them what alternative submission methods there are for that insurance company.  Resubmit your claims via fax, secured email, or whatever they require.

Step 3:  Adjust Claims as Needed

If your claims are on file but are failed, speak to you representative and ask them what is required to adjust, refile, or appeal your claims that are denied or incorrect.

If they tell you to refile to a different place, do so immediately.

If they tell you to resubmit to the same place, ask them if they can adjust your claims on the phone together.  If not, resubmit.

Your goal is to ensure that your claims are on file and processing.

Step 4:  Wait for Payment!

Wait to get paid!  If they are denied, call and go through the aforementioned troubleshooting: ensure they are going to the right place, are on file, and adjusted.

That’s it!

Conclusion

How to troubleshoot your claims, formatted in a list:

1. Verify Claims Submission Address
2. Resubmit Your Claims
3. Ensure They Are On File
4. Adjust or Appeal Your Denied Claims
5. Wait for Payment!

And if you are really stuck, contact us to see how we can help!