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Claims Not On File After Submission-Big Struggle with Insurances

Posted on August 21, 2017 at 2:10 PM

Electronic claim submission is amazing and provides a tracking mechanism for claim submission.  However, many insurances are still non participating in the electronic payer process.  In fact, it probably works to their benefit to keep it that way so they can delay claim payment.

The most frustrating aspect of dental billing is the "claim not on file" claim status.  We work diligently to send clean claims and when the claim is unresolved for over 30 days, we call the insurance company to find out why the claim has not paid.  It is the most annoying answer that our specialists hear from the insurance reps-"Your claim is not on file".  

What do we do then?  This often happens with claims that are mailed due to the insurance being a non electronic payer. The mailed claim is always "lost" somehow.  The first thing that needs to be done is the patient's demographics and the office demographics must be verified with what insurance has on file with the subscriber and the provider.  Request the claim be faxed to a supervisor.  Do not hang up until the fax is received or you get a supervisor's contact information.  If supporting documentation is necessary especially xrays, the fax will not work since the xrays are non diagnostic off of a fax transmission.  But that is ok, first get the claim on file via fax, to avoid timely filing issues, then you can follow up in a few days and submit the supporting documentation via mail certified mail to the supervisor.

Categories: dental insurance, dental technology, practice management

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