Monday, September 17, 2012

How to Simplify Your Claims and Appeals Process

The American Medical Association (AMA) published a helpful guide titled: "Appeal that Claim - Be informed. Be approved. " on how to simplify your claims and appeals process by assuring proper payment to streamline your claims revenue cycle and streamlining your claims audit and appeals procedures

The guide was divided into the following sections:
  • Step 1: Determine who will be responsible for auditing health insurer payments
  • Step 2: Collect recommended health insurer auditing resources
  • Step 3: Run monthly collection reports
  • Step 4: Review the health insurer basis for the denied, delayed, or partially paid claim
  • Step 5: Gather supporting documentation to corroborate reversal of the health insurer's determination through the claims appeals process
  • Step 6: Develop a claim appeal letter and resubmit the claims to the health insurer
  • Step 7: Maintain a health insurer follow-up log
  • Step 8: Hold claims processing and review meetings
  • Step 9: Continue to appeal partially denied, delayed or partially paid claims
Also contained in the guide are checklists and sample documents to assist you in the claims appeals process.

To download and view the guide, please go to the following link: Appeal that Claim - Be informed. Be approved.