An update was recently made on the Provider Profile Report which brings the grid into balance, and updates the values displayed, including a new row titled ‘Closed’.
A total in the Pending column will be populated on the Closed row. This total represents the dollar amount of claims that are in a Closed status but with an outstanding balance. The most common reason for claims in this section are claims that are not payable due to timely filing guidelines.
Regarding timely filing, consider an example where a claim with a service date of January 1, 2020 is submitted on May 1, 2020, exceeding the 90-day timeline. If the claim is not fully paid by Insurance or Medicaid, any outstanding balance will not be paid through Escrow. As a result, the claim will move to a Closed status with a remaining balance on the claim.
A user can obtain a detail list of these claims via the Claim Research Report and clicking the ‘Claims Greater Than 90 Days’ box; also note the guideline was effective February 11, 2019, so any service date prior to then will not be impacted by the guideline.
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