Appeals Process

Denied Claims

SMB follows-up to insure claims are getting processed in a timely manner and if claims are older than 30 days we contact the insurance company to find out why.  If a claim is denied we take several steps to get that claim resolved and the Doctor paid.

 Today it is not unusual to have a 30 percent or higher claim-rejection rate, which requires extensive follow-up.  Lack of follow-up relating to unpaid claims and incorrect discounts applied to patients’ accounts are the two biggest problems in physician’s billing practice.

How we do it: 

  • We process the rejection by assigning a denial code for easy tracking and efficiency
  • We contact the insurance company to determine if resolution can be made via phone
  • We will request medical records from the practice and submit an appeal per the payor guidelines
  • We will contact the patient via phone or statement if the denial reason pertains to them.
  • We notate our progress per transaction and the denial remains as an open task until it is resolved

Next Page: Patient Statements

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