Insurance Follow-Up
When your revenue cycle can't afford to stop.
What Insurance Follow-Up Actually Is
Once a claim leaves your practice, the work is not done. Insurance follow-up is the process of checking on submitted claims, finding out why unpaid ones have not moved, and taking action to get them resolved.
A claim that sits without follow-up is a claim at risk. Timely filing deadlines expire. Appeals windows close. Payers do not chase you down to remind you. That responsibility belongs to your team.
Insurance follow-up means investigating the status of submitted claims and pursuing a defined process until each one is either paid, denied and appealed, or appropriately closed.
What Can Happen to a Claim After Submission
When a claim is sent to a payer, one of five things typically happens:
| Outcome | What It Means |
|---|---|
| Paid correctly | Expected reimbursement received within a reasonable timeframe. No further action needed. |
| Paid incorrectly | Payment received, but the amount is wrong. Could be too little or, occasionally, too much. Both require action. |
| Denied | No payment issued. A reason code is provided. Action is required to appeal or correct and resubmit. |
| Pending or in process | Payer has the claim but has not yet adjudicated it. May need follow-up if it stays here too long. |
| No response | Nothing received. The claim may not have transmitted successfully, or it may be stuck in a queue. Follow up immediately. |
Open Claims: Your Starting Point
Claims that have been submitted but not yet paid or denied are called open or outstanding claims. Your practice management system can generate an open claims report so you can see exactly what is sitting out there and for how long.
The two main ways to check claim status are:
- Electronic query through your clearinghouse or the payer portal (Waystar handles this for your practice)
- Phone call to the payer when electronic status is not available or not conclusive
When you reach the payer, the goal is simple: confirm receipt and get a timeline. If the claim was not received, resubmit it. If it was received, find out when payment is expected or what is needed to move it forward. Document everything in the account notes.
How to Prioritize Your Follow-Up Work
Not all unpaid claims are equally urgent. Prioritize your follow-up work based on two factors:
- Deadline risk — how close is the timely filing deadline or the appeal window for this claim or payer?
- Dollar amount — higher-balance accounts represent greater financial risk if they age out or are lost
It does not help your practice to spend time crafting a detailed appeal on a claim whose deadline has already passed. Work the highest-risk, highest-dollar accounts first, and set your queue up to surface those automatically when possible.
At minimum, every open claim should be reviewed 45 days after initial submission. For Medicare, that window is shorter: expect a response in 12 to 17 days, and follow up by day 20 if nothing has arrived.
Follow-Up Timeline by Days Outstanding
Confirm receipt. If no response, query status electronically or call. If not received, resubmit. If received, document expected payment date or what is needed.
Universal minimum follow-up point. All open claims should have a note in the account by this date, regardless of payer.
If still unpaid: re-confirm status, determine reason for hold, assemble documentation, escalate the appeal process. Contact the patient and request their assistance if appropriate.
Document all efforts to date and escalate to the business office manager or treating provider. A formal recommendation for next steps is required at this stage.
Working Payer Correspondence
Payers send letters and notices about specific claims. This is called correspondence, and it should never sit in a pile waiting to be worked later. Correspondence often contains information that is more current than what you would find by calling the payer directly.
Best practice: scan every piece of correspondence, attach it to the correct encounter in your practice management system, and work it the same day it arrives. A single letter can affect multiple claims from the same payer, so the sooner you act on it, the better.
Documenting Your Follow-Up
Every action you take on an account needs to be recorded in the account notes. This is not optional. Good documentation protects your practice, supports appeals, and allows any team member to pick up where someone else left off.
Each note should include:
- Date of follow-up
- Who you contacted and how (phone, portal, clearinghouse)
- What you were told or what you found
- What the next action is and when it is due
If your system supports tickler or task queuing, use it. Automated prompts reduce the chance that accounts fall through the cracks between follow-up cycles.
Performance Benchmarks for Insurance Follow-Up
These benchmarks are not arbitrary targets. They reflect what well-run practices achieve when their follow-up process is consistent and documented. If your numbers fall outside these ranges, the follow-up workflow is usually the first place to look.
Check Your Understanding
Answer all three questions correctly to unlock Module 3.
1. What is the minimum frequency for documenting follow-up notes on an open insurance account?
2. When prioritizing open claims for follow-up, which two factors matter most?
3. A claim was submitted and 50 days have passed with no response from the payer. What is the correct first step?
You completed Module 2. Module 3 is unlocked below.
Continue to Module 3 →