The Outstanding Claims Report displays unresolved claims that are outstanding as of a specified date. The report also displays the aged totals for those claims.
Note: A claim is considered to be unresolved if any of the following criteria are met:
Overdue - The claim is considered to be overdue if both of the following apply to it:
The claim was submitted longer ago than the cutt-off date (1-360 days) that has been specified for the corresponding carrier.
The claim has one of the following statuses: Sent, Paid (the payment was sent by the carrier but not received by your office), Accepted, Pending, Queued, Printed, Resubmitted, Settled, or Attachment Hold.
Rejected - The claim is considered to have been rejected (by the payer or clearinghouse) if it has one of the following statuses: Zero Payment, Rejected by eServices, Rejected by Payer, Unprocessable Claim, Additional Information Requested, or Attachment Error.
Requires additional follow-up - The claim is considered to be unresolved if it was previously unresolved, a follow-up reminder was applied to the claim, and the specified number of days for that reminder has elapsed.
To view the outstanding claims report
Do one of the following:
On the Home menu, under Insurance, click (or tap) Outstanding Claims.
On the Home menu, under Location, click (or tap) Overview. On the location's Overview page (dashboard), the Insurance A/R Overview box displays a graph that represents for the past three months the percentage of unresolved claims that were created over 30 days ago.
On the Home menu, under Reports, click (or tap) Insights. The Insights page opens. In the Insurance box, click (or tap) the Outstanding Claims link.
The Outstanding Claims page opens.
Set up the following options:
As Of - Outstanding claims up to the specified date will be included on the report. Leave the current date selected, or enter a different date.
Note: The creation date of a claim is used to determine if that claim is outstanding as of the specified date.
Period - The aged totals will be calculated up to the current date or for the selected age of claims. Select All (0-15 days), Over 15 (16-30 days), Over 30 (31-45 days), Over 45 (46-60 days), or Over 60 (61+ days).
Note: The creation date of a claim is used to calculate the aged totals.
Carrier- To include outstanding claims for any insurance carrier on the report, leave All selected. To filter the report to include outstanding claims for a specific insurance carrier, select that insurance carrier from the list.
Plan - If you have selected a specific insurance carrier from the Carrier list, the Plan list is available. To include outstanding claims for any plan under the selected insurance carrier on the report, leave All selected. To filter the report to include outstanding claims for a specific plan under the selected insurance carrier, select that plan from the list.
Click (or tap) Search.
To print the report, click (or tap) Print.
You can click (or tap) the name of a subscriber in the Subscriber column to open the corresponding patient's Ledger page in a new browser tab or window.
You can click (or tap) the name of a patient in the Patient column to open the corresponding patient's Ledger page.
You can click the name of an insurance carrier in the Insurance Carrier column to view the corresponding carrier on the Insurance Carriers page.