What is the best way to follow up on unpaid insurance claims?
Start following up at 30 days after submission. Waiting until 60 or 90 days to check on claims means you’ve already lost valuable time. Insurance companies have filing deadlines for appeals and corrected claims, and those clocks start ticking whether you’re paying attention or not.
Check the payer portal first before calling. Most major payers let you look up claim status online, and this takes two minutes instead of waiting on hold for 45. The portal will show if the claim was received, if it’s pending, if it was processed, and often why it was denied. Get this information before you pick up the phone.
When you do call, write down everything. Date, time, representative name, reference number, and exactly what they said. Insurance companies sometimes give different answers to the same question, and having documentation protects you when you need to escalate or file an appeal. Without notes, you’re starting from scratch every time.
Ask specific questions. “What is the status of this claim?” gets you vague answers. “Was this claim received on October 15th, what is the current status, and what date will it be processed by?” gets you useful information. If they say it’s in process, ask for an expected completion date and a reference number for the call.
Common issues that hold up claims include missing patient information, incorrect provider numbers, authorization problems, and coding mismatches. Working with Macomb County bookkeepers who understand healthcare billing helps ensure payments get recorded correctly and discrepancies between what you billed and what you received don’t slip through unnoticed.
Track your aging buckets and work them systematically. Claims at 30 days get a portal check and a call if needed. Claims at 45 to 60 days get escalated to a supervisor if the first level reps can’t resolve them. Claims at 90 days or more need appeal letters and formal dispute processes. Having a schedule prevents claims from falling through the cracks.
Some denials require formal appeals. These have strict deadlines, often 60 to 180 days from the denial date depending on the payer. Missing an appeal deadline means losing the right to contest the denial entirely. When you get a denial, check the appeal window immediately and put it on your calendar.
If your accounts receivable keeps growing or you’re writing off claims that should have been paid, the issue is usually follow-up consistency rather than payer behavior. Many practices handle this internally until the situation becomes unmanageable. Outsourcing medical billing to specialists who work claims daily often recovers more than enough revenue to cover the cost.
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