Managing unpaid or underpaid claims can be one of the most challenging aspects of medical billing. Unresolved claims lead to revenue loss and impact the cash flow of healthcare practices, making efficient follow-up crucial for maintaining financial health. At eHealthBilling, we specialize in proactive claims management, ensuring that every claim is followed up meticulously to maximize reimbursement. Below, we share insights on how we handle follow-ups for unpaid or underpaid claims to keep your practice running smoothly.

Step 1: Identify the Issue Early

The first step in handling unpaid or underpaid claims is timely identification. At eHealthBilling, we use advanced billing software that tracks and flags claims with payment delays or discrepancies as soon as they arise. This early identification enables us to act quickly and avoid aging claims that become harder to resolve over time.

Step 2: Analyze the Reason for Denial or Underpayment

Once a claim is flagged, it’s essential to determine why it was unpaid or underpaid. Common reasons include coding errors, missing documentation, or incorrect patient information. Our billing experts at eHealthBilling thoroughly review each claim, including checking for:

• Incorrect medical codes (CPT, ICD, or HCPCS)
• Eligibility issues or expired coverage
• Authorization or referral requirements
• Coordination of benefits between primary and secondary insurers

We ensure that these errors are identified and corrected before resubmitting the claim.

Step 3: Proactive Claim Follow-Up

At eHealthBilling, our team is proactive in following up on unpaid or underpaid claims. We engage directly with insurance companies to clarify the reason for the claim’s rejection or partial payment. By maintaining constant communication with payers, we expedite the resolution process. This involves:

• Phone calls to insurance companies to get real-time updates
• Tracking claims status through payer portals
• Submitting necessary documents or information promptly

Step 4: Appeal Denied Claims

For denied claims that are unjustified, eHealthBilling takes immediate action to file appeals. Our team carefully prepares the appeal by gathering all supporting documentation, including medical records, authorization forms, and corrected codes. We then submit the appeal within the designated time frame to increase the chances of claim approval.

Step 5: Resubmit Corrected Claims

In cases of underpayment, eHealthBilling resubmits the claim with corrections based on the insurance company’s feedback. We ensure that any missing information is added, coding errors are fixed, and the claim is resubmitted promptly to avoid further delays. Our goal is always to maximize the payment owed for the services rendered.

Step 6: Monitor and Report

After resubmitting or appealing a claim, continuous monitoring is key. At eHealthBilling, we keep an eye on every claim until it’s fully resolved. Additionally, we provide healthcare practices with detailed reports on their outstanding claims, allowing them to have full transparency regarding their revenue cycle.

Step 7: Patient Follow-Up (If Necessary)

In some cases, the issue with an unpaid claim may be tied to patient responsibility, such as incorrect insurance information or lack of payment for deductibles and co-pays. eHealthBilling handles these cases delicately, contacting patients to resolve any issues and ensuring that they understand their financial obligations.

Why Choose eHealthBilling for Your Claims Management?

Efficient follow-up on unpaid and underpaid claims is essential for optimizing the financial health of your practice. At eHealthBilling, we not only address these issues promptly but also prevent them from occurring in the first place through proactive claims management. With years of experience and cutting-edge technology, we help practices recover revenue that might otherwise be lost, giving you the peace of mind to focus on patient care.

Conclusion

Unpaid and underpaid claims are inevitable, but they don’t have to be a financial burden. By partnering with eHealthBilling, you can ensure that every claim is handled with precision and professionalism, maximizing your revenue and reducing unnecessary delays. Let us take care of your claims, so you can take care of your patients.

Contact eHealthBilling today to learn how we can improve your practice’s financial performance through expert claims follow-up services!