Managing Unresolved Claims

Managing Unresolved Claims

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Unresolved Claims ?!  What should I do with these claims that are just sitting in this section and not going anywhere? My understanding is that they are not going anywhere without some correction and yet I see nothing wrong with them.
 
OHIP claims are considered to be Unresolved due to their service date bring 6 weeks ago. There could be many reasons why these have not been paid yet:
  • They were just entered with a service date that is older then 6 weeks
  • They were not processed by OHIP as would be expected
  • They were processed and paid but were not reported on an RA
  • They were submitted but were processed as rejected but the error report was malformed.
It does not really matter why OHIP claims remain unpaid for over 6 weeks.
What we are interested in is in the doctor’s getting paid. So if you have a claims that were supposed to be paid then click them “Mark as Unsubmitted”, in Billing Cycle.

Tracking previously resubmitted OHIP claims:

The challenge, especially in older claims, is how do I followup? How do I know when the claims were last submitted?
Fortunately HYPEMedical’s Billng Cycle makes that easy. Before clicking Find on your next “Unresolved” search, check mark the Last Submitted Date column.
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