Visual Flow Chart
Rollover a step to see details about that particular part of the process.
If we have not received payment after 45 days, the claim is resubmitted to the insurance company.
A tracer is also sent to the patient with the insurance information and notification of nonpayment to date by their insurance. Balance will be billed to patient.
If a claim has not been paid or denied within 60 days, the claim is denied and the patient is billed.
Many insurance companies will now consider a claim delinquent and refuse to pay if it has not been received within 90 days.
If an oversight at your office allowed a patient to be seen without verifying insurance, we will alert the patient.
At this juncture, claims that have been returned to us with corrected information are refiled.
In cases where the problem cannot be resolved because the claim was denied for lack of coverage, we then bill the patient with an explanation.
Within three business days of receipt all clean claims whcih qualify are submitted to third party payors electronically.
Any documents necessary to support manual claims - such as a claim that has more than three surgical procedures or worker's compensation claim - are attached and submitted with the claims.
After the reason for the rejection is discovered, if it has been denied due to lack of coverage or because of incorrect policy information, KLA will contact both the insurance company and the patient, in an attempt to resolve the issue, so billing can be processed.
If the claim is rejected and the problem stems from lack of appropriate authorization by the practice, the practice will be notified.
KLA believes that it is your practice and your decision how you wish the claim to be handled, and we will wait for your response before we take any further action.
Once answers are returned from provider's office they recieve expedited handling.
These claims will generally reenter the process within 24 hours of receipt at KLA.
On a daily basis, electronic correspondence from most of the private and government payors is downloaded into our system.
Denials are researched in our office. If we have inadequate information, requests for this information are sent to the practice.
Patients are contacted by KLA should denials be because of incorrect insurance or demographic information.
First encounter for which KLA bills:
- Patient information forms
- Copies of insurance cards
- Fee ticket (i.e. superbill, hospital card)
All other encounters:
- Fee ticket with unique patient id and any changes in patient demographics
All data will be compiled and pinput by KLA's professionally trained staff.
Queries as to any potentially missed charges or data will be input into the system.
Presubmission edits include: bundling, review and medical necessity - and will be run prior to submission.
KLA will provide you with preprinted envelopes which will be sealed by date to quickly identify the work and ensure it is routed to the proper workgroups at KLA.
KLA will provide courier pickup in the Mid-South or Federal Express Service for all other locales so you can conveniently send your work to us in a secure, expedient manner.
The patient's information documents will be stapled together by patient.
Data summarized by day:
- Number of superbills
- Total of patient payments
KLA will work with practice to develop a cover sheet to conveniently summarize the data being sent to KLA.
After billing a patient 3 times for an encounter, without a response from the patient, the account is returned to the provider.
KLA will write-off, prepare for collections, etc. as directed by the provider. Should the patient be treated for any subsequent encounters, KLA will include all upaid charges on the patient's billing along with the current charges.
Frequently, claims that are apparently accepted by the insurance company seem to disappear.
When this happens, and no response, rejection or denial is received by KLA from the insurance company, we will conduct a follow up on the claim to try to ascertain the problem and correct it, if possible.
Receipt listings are compared with transmission listings for accuracy.
Any missing transactions are refiled at this time.
All clean submissions are processed for payment.
Patients are then billed - up to 3 times - if no secondary insurance is on file.
All payments received are posted to the oldest listings from the patient's outstanding balance - unless alternate instructions are provided to us by the practice.
KLA posts all payments and adjustments to the patient's account. KLA uses open item accounting to ensure that all payments are posted against the individual date of service and the individual procedure code that was paid.
This CRITICAL step in the reporting phase helps the practice to determine what procedures are the most profitable to their practices.
Clean claims that have been electronically filed are usually paid within thirty days.
Payments are deposited into practice account directly. The practice controls where the payments go. KLA will make arrangements with insurance companies that will result in their electronic deposits being deposited into the practice's bank account whenever this is possible. KLA suggests using a bank lockbox service.
Queries concering missing data elements, miscoding, possible coding omissions or any claims that are not in compliance with the current coding standards will be sent back to Provider's office to be corrected or clarified.
Claims submission will be held pending the Provider's response.
All rejections are thoroughly analyzed.
The input is double checked for accuracy.
If the rejection is due to an input error, the claim is then corrected and refiled within 24 hours.
If a procedure is denied, KLA researches the reason for the denial. If it is inappopriate, the claim is appealed.
Secondary insurance is tracked in same manner as primary insurance filings.
(If there is no secondary insurance, the patient is billed up to three times.)
If KLA receives updated information directly from provider's office, claims are refiled with the new information.
If new insurance information is provided at a later visit, any unpaid claims will be automatically refiled using the new information, along with the new claim.