1. EOB Review & Reconsideration Actions
Review Explanation of Benefits (EOB):
Identify denial codes and reasons for claim denials.
Cross-reference with payer-specific denial code descriptions.
Take Corrective Action:
If due to coding or billing errors, prepare and submit a corrected claim- adding modifier and changing CPT code.
If denial is disputable, initiate a reconsideration or formal appeal.
Review and attach relevant medical records or documentation to support the appeal.
2. Waystar Claim Rejection Review
Access Claim Form in Waystar:
Identify rejection reasons (e.g., missing info, invalid codes, eligibility issues).
Correct and Resubmit:
Update claim details as needed.
Ensure all required fields are completed accurately.
Confirm successful submission and track claim status.
3. Payment Posting from Remittance/EOB
Review Remittance Advice or EOB:
Match payments to corresponding claims.
Post payments accurately in the billing system.
Note any adjustments, patient responsibility, or secondary billing needs.
4. Insurance Follow-Up (Phone & Portal)
Check Insurance Portals First:
Look for claim status, payment info, or denial details.
Call Insurance Providers If Needed:
Contact payers like Medicare, UHC, BCBS, CIGNA, Workers Comp, TRICARE, UMR, etc.
Inquire about claim status, missing information, or appeal outcomes.
Document call details and next steps in the billing system.
5. Assigned to veirfy patient eligibility for rare case
