Chasing claims that were acknowledged and then went quiet
A 999 confirms the envelope opened. A 277CA confirms each claim inside cleared intake. Neither confirms that anybody is adjudicating anything, and claims do go missing between that acknowledgement and the remittance without a code being emitted anywhere. So the queue gets built from age rather than from an event, checked by a 276 status request where the payer supports one and worked in a portal where it does not. What makes it urgent is the filing window, which differs by payer and by contract.
Electronic eligibility answers whether a patient is covered, and then somebody opens the payer portal anyway to find out what is actually payable.
There is a mandated electronic standard for eligibility, and it works. It confirms that a plan is active. What it routinely omits is the detail the front desk actually needs: frequency limitations, waiting periods, alternate benefit provisions and remaining annual maximum. That gap is the origin of most manual verification in this sector.
- Availity
- athenahealth
- Google Sheets
When this is the wrong thing to build
Pick something else if the payer mix is small enough that the aging report fits on one screen, or if claims are submitted through a service that owns follow up under its contract, because two parties chasing the same claim produces duplicate submissions rather than answers.
The constraint that shapes it
A practice is a covered entity, and any vendor that creates, receives, maintains or transmits protected health information on its behalf is a business associate, which requires a written agreement in place before any disclosure. More on how this sector works.
A list of things that are missing, worked until it is empty. Read what this shape is, or start from one of these.
- Chasing a compliance file to complete
- Chasing a referral fee through to a closing you cannot see
- Asking for the replenishment before the retainer runs to zero
- Chasing medical records until the set is complete
- Getting a deposition on the calendar of every party
- Chasing the warranty credit the distributor has not issued
- How do I tell if a payer ever received my claim?
- What is the difference between a 999 and a 277CA?
- Claim shows accepted at the clearinghouse but the payer has no record, why?
- How do I check dental claim status without logging into each portal?
- What happens if a claim passes the timely filing window?
Back to medical and dental practices, or see how this is priced and scoped.