Some of the most time-consuming and frustrating hospital claims are the ones requiring information from the patient. Everything was done correctly by the hospital business office but the payer will not process the claim until the patient provides additional information. Information requests that hold up payment include:
- Claim forms
- Student status
- Accident details
- Dependent documentation
- Prior medical history forms
- Eligibility information updates
- Certificates of Creditable Coverage
- Medical records from other providers
- Medicare common working file updates
- COB information (including Medicare COB)
- First Report of Injury (workers Compensation)
The first thing RSource does with one of these requests is to determine if the request is actually reasonable. When it’s not, an RSource Attorney takes over and gets the claim paid, usually without even involving the patient.
But when the information is needed, an RSource Patient Advocate steps in and makes contact with the patient through a combination of telephone calls (including after-hours and weekend calls), letters (including certified mail), and even visits to the patient’s home if that’s what it takes. Once contact is made, RSource helps the patient comply with the information request and follows-up with the payer until the hospital receives payment.