Insurance Follow-Up & Denial Management

Round 3 — Module 2 · Working a claim until it's actually resolved

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Round 3 Progress

Payment Posting & Remittance

Insurance Follow-Up & Denials

Patient Statements & Collections

A Claim Isn't Done Until It's Paid

Submitting a claim is not the finish line. Until a claim is either paid in full or resolved through appeal, it sits in accounts receivable, aging by the day. Follow-up is the work that closes that gap — and it only happens if someone is actively watching for it.

Types of Denials You'll See

Eligibility Denial

The patient wasn't covered on the date of service, or coverage had changed. Usually traced back to eligibility not being re-checked at the visit.

Authorization Denial

The service required prior authorization that wasn't obtained, or the authorization on file had expired or run out of approved visits.

Coding / Documentation Denial

The billed code doesn't match what the documentation supports, or a required modifier is missing.

Timely Filing Denial

The claim was submitted after the payer's deadline. These are usually not appealable, which makes prevention the only real fix.

The Follow-Up Habit That Matters Most

A claim that hasn't been touched in 30 days is a claim that's quietly aging. Regularly working an aging report — instead of waiting for a denial to show up — catches problems while they're still fixable.

Where Follow-Up Breaks Down

Common gaps: claims that sit untouched because no one owns a regular follow-up schedule, denials that get noted but not actually reworked, and timely filing deadlines that pass because a claim was corrected but never resubmitted.

Check Your Understanding

1. What usually causes an eligibility denial?

Correct. Eligibility denials usually trace back to coverage changing without being re-verified.

Not quite. This type of denial is about coverage status, not coding or timing.

2. Why are timely filing denials especially serious?

Correct. Timely filing denials are usually final, which makes prevention critical.

Not quite. These denials are serious because they're typically not appealable.

3. What is the risk of only reacting to denials as they come in, instead of working an aging report?

Correct. Without proactive follow-up, claims age silently until they become harder to fix.

Not quite. Waiting to react means claims can age past the point where they're easily fixable.

Nice work — continue to Module 3.

Continue to Module 3