Process Denied Service Claims

Submitted by admin on Tue, 05/04/2021 - 15:37
Policy: 

Service Claim Denials are processed within 10 days of an Service Claim payment being posted. The <<Staff Title>> researches each denied claim. Where applicable, the <<Staff Title>> adjusts the claim and resubmits it. The Service Claim Accounts Receivable is updated per denials and resubmissions.

Procedure: 

 

  1. After a payment is posted for an service claim submission  <<Staff Title>> completes denial process within 10 days
  2. <<Staff Title>> goes to <<File Path>>
  3. <<Process will vary depending on state and F/EA procedures>>
Internal Controls: 

The internal controls used by F/EA to monitor this process establish responsibility, segregate duties, document procedures and ensure independent internal verification.

  1. <<Staff Title>> researches each denial and corrects denials as appropriate.
  2. <<Staff Title>> reconciles denied and rebilled amounts from claim to billing system.
  3. A Billing Control sheet is completed showing denied and re-billed claims.
  4. The year-to-date accounts receivable balance for service claims in the billing system is reconciled to the Accounts Receivable balance in the F/EA Billing Control sheet.
  5. A Tracking Number confirmation receipt is printed after submitting rebilled denials to State submission website.
  6. F/EA Accountant posts journal entries.
  7. F/EA Accountant reconciles General Ledger to appropriate supporting documents at month end.
  8. F/EA Accountant produces reconciliation documents, verifies, signs and dates.
  9. <<Staff Title>> reviews, verifies, signs and dates reconciliation documents