Insurance calling process - Script for denied claims

Insurance calling - step by step for denied claims




If A/R caller receive this answer, then the following information needs to be obtained from the insurance representative,


1. What is the denial date of the claim?
2. What is the reason for the denial?
3. Check whether the denial reason was correct or not.
4. If the reason is incorrect, then ask the insurance representative to send the claim for reprocess.
5. Then, get the reference # or the claim # pertaining to that claim.
6. How long it takes for reprocess?
7. If the situation arises for appeal, then get the appeals mailing address and get the name of the person to whom the appeal is to be sent.
8. Close the call. *


Calling script for denied


DAVID is the name of the person in our billing office and he is calling the insurance company BC/BS of MD for checking on claim status.

DAVID : Dialed insurance company telephone #.

Insurance Rep : Picks the phone “ Thanks for calling, this is SANDY, how may I help you today”

DAVID: “My name is DAVID, I am calling from Doctor office and I would like to check claim status for a patient”

SANDY : “Which doctors office you calling for?”

DAVID : “I am calling from General Oncology Associates”

SANDY : “What is your telephone #?”

DAVID : “My telephone # is 1-800-295-6792”

SANDY : “What is the patient’s Social Security Number?”

DAVID : “ The social security number is - - - - - - - -“

SANDY : “Can you hold for a moment, I will pull up this patient record”

DAVID : “ Yes, Please”

SANDY : “who is the patient?”

DAVID : “ patient name is Linda Far”

SANDY : “what is the date of service?

DAVID : “01/26/2008”

SANDY : “what is the billed amount on the claim? DAVID”

DAVID : “Yes, SANDY, the billed amount on the claim is $1500.00”

SANDY: “Can you hold for a moment, I will search for that claim”

DAVID : “Yes, SANDY”

SANDY : “Thank you so much for waiting and appreciate you patient, and this claim was denied"

DAVID : “what is the denial date of the claim?”

SANDY : “03/10/2008”

DAVID : “What is the reason for the denial?”

SANDY : “this claim was denied due to lack of referral”

DAVID : “What is your claim# for this claim?”

SANDY : “The claim # is -----------“

DAVID : “Can I fax the referral”

SANDY : “yes, you can”

DAVID : “What is your fax # and to whom do I need to fax the same?”

SANDY : “Fax # is 410-528-7121 and you can fax it to my attn.”

DAVID : “How long it takes for reprocess this claim after receiving the fax?”

SANDY : “it usually takes 2 to 3 weeks to process”

DAVID : “Thank you so much for your information and have a nice day”

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