AR Analysis - Step 4

Step Four: Identification of the problem – Calling


If the claim has been prepared and submitted correctly as per insurance requirements, and usual turnaround time has passed, call needs to be placed with respective insurance carriers to ascertain the status of outstanding claim.

Analyst or AR Caller obtains the required information from the insurance company and documents the results of the call in the patient notes section of patient account. Appropriate steps needs to be initiated to settle outstanding claims based on the call notes.

Examples of the kind of situations that the analyst may come across and the action initiated are given below:

(a) The AR night caller may have documented in patient notes that according to the insurance representatives the claim is not in their system, meaning they don’t have a record of the claim. The AR analyst may now check the claim address and review transmission reports to find out if the claim failed to reach the carrier due to a bad address or a transmission error. If the address in the system is incorrect, the analyst first finds out the number of claims that have been affected due to the wrong address. Or if there was a transmission error, how many claims were affected.

(b) Caller patient notes reveal that claims have been denied. Then analyst initiates appropriate action based on the reason for denial as documented in patient notes.

(c) The insurance carrier may state that the claim has been settled. In such cases, the AR caller obtains the payment date and checks details from the carrier and documents them in patient notes. The analyst follows up with the cash department on whether such a payment has been received. If the check the carrier says has been issued has not been received and posted within two weeks from the day of payment, he/she may prepare a report (depending on the policy established by the client) on such missing checks and sends it to the client.

(d) An issue may need feedback from client for proper resolution. If so, the analyst sends a report to the client detailing the issue and seeking clarifications.