PracticeWorks: Running the Outstanding Insurance Claims Contact Expert

Document created by tshaw Employee on Aug 23, 2016
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The Insurance Claims Contact Expert is used to search for insurance claims that have not been paid. Ideally, this Contact Expert should be run daily or when your Office Expert prompts you to so that you can contact the insurance company, the insured party, or resubmit the claims, if necessary.

 

The most common uses for the Insurance Claims Contact Expert are to:

  • Generate a list of outstanding claims so that you can contact the insured party or insurance company.
  • Contact insurance companies or insured parties by phone or resubmit claims.
  • Make notes about an attempted contact and establish a recontact date in case the claim is not resolved within a time period you specify.

 

From the Experts menu, select Contact Expert>Outstanding insurance claims. The criteria entry window is displayed.

Enter your search criteria for the following variables:

  • Number of days outstanding for paper claims
  • Number of days outstanding for electronic claims
  • Whether to include claims for which contacts were previously made
  • Production owner
  • Types of claims to include

 

Click OK to generate the results. After the search is complete, the Delinquent Insurance Claim Contact Expert window is displayed.

 

  • You can sort the list using the Days old column. Your sort settings are saved, so if you sort using this column, the next time you open the expert, it uses your sort preference automatically.
  • When you select entries in the list, the bottom half of the window displays the details of the currently highlighted entry. Use the Actions button to choose whether to apply the action to the entire list, or to the selected record.
  • You can click the Auto dial button to access the on-screen dialer to phone the insurance company. You can use the other buttons to view information about the insured party, the applicable insurance plan, and information about the patient’s claim.
  • The Contact information area displays the date of the last contact for the selected patient. Use the Contacted button access the New Contact Entry window. The Resubmit and Clear claim buttons can also be used to take action on the selected claim.

 

NOTE: If you check the Show only claim contacts check box in the New Contract Entry window, you can limit the type of comments that are shown to those that deal with claim contact information only.

 

IMPORTANT: If you indicate a Re-contact if no action by date in New Contact Entry window, the patient for whom the recontact date has been set is excluded from any future Insurance Claim Contact Experts as well as the Office Expert. If you want these patients to be listed on your next Insurance Claim Contact Expert, make sure you check the Include patients already contacted check box on the Insurance Claim Contact Expert Criteria window.

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