Daily Claims Process
Implement a daily process to resolve slow, under and no paid claims for the healthcare provider. The low impact way becomes an extension of the provider's billing staff efforts to deal with the claim issues created by the insurance companies.
Combining individual claims from various providers per payer allows PPCN to put the payers on notice that their delay tactics and inconsistency in the adjudication of claims is being monitored. Not only on individual claims, but also 1000's of claims statewide.
The systematic approach will identify:
1. Slow payments under the state prompt pay law guidelines.
2. Interest and penalties owed to the provider on slow payments.
3. Validate payments are in compliance with contractual rates.
4. Patterns of denial by the payer on individual items per claim.
5. Payers will be notified of any non compliant claim.
6. Payer's non response will be reported to the Insurance Commissioner.
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