GuidesTill and payments
Insurance claims in order
What to send, when, and how to follow up until you get paid.
A process, not a loose task
Collecting from insurers is money your clinic has already earned. What makes the difference is treating it as a process with fixed steps: verify before treating, document well, send on time and follow up until payment.
When every step has an owner and a date, insurance money arrives predictably, month after month.
Before treating
Most objections are avoided before the patient sits in the chair:
- Confirm the patient’s insurance is active and which plan they have.
- Check what that plan covers for the procedure and how much the patient pays.
- Request the authorization when the procedure needs one, and write down the number.
- Copy or scan the insurance card and the ID.
What each claim includes
Every insurer has its own format, but almost all ask for the same things. Keep a checklist and never send anything incomplete:
- Patient details and member number.
- Authorization number, when it applies.
- Procedures with their codes, dates and teeth.
- Amounts: what insurance covers and what the patient paid.
- Patient’s and doctor’s signature, if the insurer requires it.
- Supporting documents: X-rays or reports when the procedure requires them.
Send in batches, on fixed dates
Instead of sending each claim whenever you remember, group them by insurer and send them on fixed dates, for example weekly or every two weeks. Always check each insurer’s deadline for receiving claims: what’s sent late may not get paid.
Keep a copy of every batch you send, with the date and the total. That copy is your reference when the payment arrives.
Follow up until paid
Give every claim a status and review the list weekly:
| Status | What it means | What to do |
|---|---|---|
| Pending | Treated, not sent | Include it in the next batch |
| Sent | The insurer received it | Wait for the agreed payment period |
| Objection | Fully or partly rejected | Fix and resend quickly |
| Paid | The money reached the bank | Reconcile and close |
When a claim passes its deadline unpaid, call or write to the insurer with the batch number at hand. Old claims are the hardest to collect: weekly follow-up keeps them from ageing.
When there are objections
An objection almost always has a simple cause: a missing signature, a code that doesn’t match, an expired authorization or a procedure that wasn’t covered. Note the cause of each one. After a few months you’ll see a pattern, and you can fix it in the “before treating” step.
Reconcile every payment
Insurers usually pay several claims in a single transfer. When it arrives, compare it with the payment detail they send and mark each claim as paid, fully or partly. Anything short goes back on the follow-up list.
Who does what
| Role | Responsibility |
|---|---|
| Front desk | Checks coverage, requests authorizations and gathers signatures and documents |
| Doctor | Records procedures, codes and teeth, and attaches supporting documents |
| Billing | Builds and sends batches, follows up and reconciles payments |
A fixed slot every week, for example Friday morning, to review the whole list makes sure nothing falls behind.
Summary
- Check coverage and authorization before treating.
- Use a checklist for every claim.
- Send in batches, on fixed dates and within the deadline.
- Review statuses every week.
- Reconcile every payment against its claims.