May 2011 Newsletter
Analyzing the Success of Claims
- How successful are my initial (Auto Bill) claims to payers?
- Are there issues with electronic claims not passing Xpeditor edits or Payer Front-end edits?
- Have you ever wondered if sending follow-up claims really generates payments from insurance companies?
- Do you know how soon to send a follow-up claim or make a call to an insurance company?
- Do COB (secondary) claims take longer for payments to be received?
These are just some of the questions that can be answered by the Web Based Claim Success report in HARP 3.0 by selecting the relevant options for the billing period, date type, and claim type.
Average Days Between Claim and Payment
Let’s start by using the report to find out something simple: the average days from the time claims are submitted until payments are posted for claims billed this year. Run a Claim Success report with the pictured options. On the report, the statistics in the column Days Between Successful Claim and Payment provide the answers to our question.
Selection options for Claim Success report
Claim Success report showing the days between claim and payment 
Follow-up Claim Cycles
Next, you might want to analyze the proper timing for sending follow-up claims. When selecting options for the report, choose a past billing month that has probably received payments, and set the Claim Type to Auto Bill. On the report, look at the average number of days between claim and payment for each payer. If your follow-up cycle for a payer in HARP is shorter than the average, you may be sending follow-up claims too soon. If your follow-up cycles are much longer than the average number of days, then you may want to make the cycles shorter so your A/R are actively billed.
Claim Success report showing the average time for payments for setting follow-up cycle
Follow-up Claim Success
Something else you might want to learn is how successful follow-up claims are for various payers. Run the report for a past billing month when payments for follow-up claims probably would have been received, and choose the Claim Type of Follow-up Bill. On the report, check the claim success statistics and percentages. If your success percentage is high, then sending follow-up claims is yielding benefits. If the percentage is low, you may want to contact that payer to determine if there is a specific problem or if another method of follow-up may be more appropriate.
Claim Success report showing success of follow-up claims
The report also shows the number of claim errors, and you can access details for tickets, such as the actual number of claims needed to receive payment, from links on the report. These are just a few examples of the powerful information you can obtain from the Web Based Claim Success report.