A/R Follow up
If the claim is not processed on the portal.
Please always check the Guarantor notes to see when the claim was last worked on, if we did not please proceed to the follow steps
1.Click on the Workqueue List
2.Click on the Follow up tab
3.Click on the 96423 SCC CPCA NO REPONSE
Please Select an account to follow up by. Then go to Prof Tx Inquiry
INVOICE TAB.
On the right side of the please click on "CLAIM STATUS"
Example of claim Status and what they indicate
Claim was printed and mailed
8 . The history of the claim will be populated accordingly. During the execution of the process, will display the date on which the claim was accepted. If you wish to review the details further, the history tab will provide a comprehensive overview of the claim's history.
| Activity | Date it was posted |
| New Claim | Date it was posted |
| Error | Claim edit work queue |
| Add WQ | claim was sent to Master files errors, No rules, User Errors |
| Force Resubmit | Claim was force to submit to clearing house |
| Review WQ | Sent back to Master files errors, No rules, User Errors |
| Accept Claim | Claim accept by clearing to payor |
| Demand (P) | Claim was drop to paper |
- Please verify the status of your claim by accessing the insurance portal. If the claim is not reflected there, kindly submit a paper claim by printing It is essential to navigate to the Invoice tab, right-click, and select "PRINT CLAIMS." Please DO NOT choose "DEMAND CLAIMS," as this will result in the inability to print the original claim with its associated date.
- Please add the required notes: Example provided below.
- Once the notes are added. Please reset the aging date so the system acknowledges there was a follow up
Missing check
- Follow steps 1 to 6
- If the website is reflecting the claim has been processed We would reach out via phone or via email to the insurance company.
Example of email regarding a missing check
Subject: Assistance Needed for Unresolved Payment Issue
Hi Alejandra,
I would like to inquire about the appropriate contacts who can assist in locating payment information. I am currently addressing a situation involving two patients whose payments reflect online; however, when I enter the check number, the search results do not yield any matches. Additionally, upon reviewing the remittance advice, I have found discrepancies between the check numbers. I am uncertain if these checks pertain to bulk payments. Moreover, when I search our bank account for the specified check number, there are no results.
Furthermore, I need to initiate a tracer for check number 1234556, issued on October 18, 2022, in the amount of $2,273.24. Could you please confirm if you are able to assist with this matter?
Thank you for your prompt attention to these issues.
Subject: RE: Assistance Needed for Unresolved Payment Issue
Good morning,
Thank you for confirming.
It seems that this check tracer has already been completed and it was determined that the check remains outstanding on our end and was cancelled on 05-18-2023 due to Staled dated check.
Attached is the warrant affidavit that has been sent to completed and returned so we can issue a replacement check. Please complete and return at your earliest convenience.
Thank you,
Provider Services Department-VS
Health Plan of San Joaquin | Mountain Valley Health Plan
Navigate to the P-DRIVE > BILLING > 01 MISSING PAYMENT folder. Save a copy of the payment in the missing payment folder along with the Affidavit. Ensure that the file is named after the Insurance Company's check number and/or warrant number
Example: HPSJ 456745
- Update the Guarantor notes stating that you have reach out via email or phone call, if a phone call was made please include the Name of the person you spoke with and/or reference number of the call. See example below.
Please research the the "bulk check" and in each account updates the notes.
Guarantor Example notes if phone call was made via phone
REP: Nancy
REF: 1-4567896543
Claim is reflecting as process Check #123456 Check date processed 10/01/24. Claim is reflected as being processed and paid. Nancy stated the check has not been cashed and will be sending our office a check. Allow up to 30-45 days.
Summary: Follow up Paid claim 10/01/2024
Type: AH Claim Status (5504
Auditing Excel
- Follow up with excel once a month
- If the payment has not been received reach out to the insurance again and document on the guarantor account that you have followed up.
- Reset the aging date again.
If the claim is denied, please have the claim work on right away.