CLAIM NOT ON FILE-AR FOLLOW UP

AR FOLLOW UP-CLAIM NOT ON FILE

• This is not a denial,Claim not on file-There is no claim received to payor or Unable to find the claim.
• Check the transmission of claim,Claim may be send through Electronically or Mail,If the claim send through mail,verify the mailing address,If the claim sent through electronically,verify the payor id respectively.If the mailing adrress is incorrect,correct the mailing address and refile the claim.It applies to payor id also.
• Before calling to payor,check the rejection list,Claim may probably rejected due to edits from clearing house,If you receive rejection,follow up the edits and work towards rejection until you find the solution,without clearing rejection,It is not possible to receive claim from the payor. Once you find the solution,Refile the claim.
• For the 1^st follow up-Verify effective date,TFL,Verify id group#,mailing address and Make sure patient is active for the dos then refile the claim if everything goes right.
• For the 2^nd follow up-Get the Fax# and send the claim through fax,
• For the 3^rd follow up-reached the EDI department,check what happened on the claim,reaching EDI department can get the right solutions for all claims.

EXAMPLE

Called xyz insurance@***-***-****,s/w Ashley,as per rep,no claim on file,verified the mailing address and payor id respectively,It is same as it is on our file,checked the eligibility,pt is eligible from 01012016 to current,Pt is active for the dos,TFL is 90 days from dos,Therefore refiled the claim to xyz.