by Marty Kotlar, DC, CPCO, CBCS •
President of Target Coding •
Question: Dr Kotlar, “What should I do when an insurance carrier requests to resubmit claims on a regular basis?”
Answer: When an insurance company acknowledges that claims were submitted but later states they were never received, causing repeated resubmissions and delays, you should take a proactive claims-management approach to protect their reimbursement rights.
Obtain Proof of Submission
- Save electronic claim acceptance reports from your clearinghouse.
- Keep claim confirmation numbers, batch reports, and transmission reports.
- If mailed, use certified mail or another trackable delivery method.
Contact the Clearinghouse
Verify the claim was successfully transmitted to the payer. Obtain documentation showing:
-
- Date sent
- Date received by payer
- Payer acceptance report
- Request a payer acknowledgment report if available
Request a Claim Trace
Ask the insurance company to perform a formal claim search or trace using:
- Date submitted
- Patient name
- Member ID
- Date of service
- Claim amount
- Clearinghouse reference number
Submit a Written Appeal
If the payer continues to claim non-receipt, send a written appeal with:
- Proof of submission
- Clearinghouse acceptance reports
- Notes of previous phone calls
- Request for claim processing based on the original filing date
Document Every Contact
Record:
- Representative’s name
- Call reference number
- Date and time
- Summary of discussion
This documentation can be valuable if the issue escalates.
Request Timely Filing Protection
- If the claim was submitted timely and you have proof, request that the insurer honor the original submission date.
- Many payer contracts and state prompt-pay laws support this position.
Escalate Within the Insurance Company
Ask for:
- Claims supervisor
- Provider relations representative
- Network management representative
Repeated “not received” responses often require supervisory review.
File a Regulatory Complaint
- If the insurer repeatedly loses claims or refuses to honor proof of submission, consider filing a complaint with your state’s Department of Insurance
- Include copies of all submission reports and correspondence
Sample Language
“We have documentation from our clearinghouse confirming that this claim was successfully transmitted and accepted by your organization on [date]. Please process the claim using the original filing date or provide written documentation explaining why the claim was not entered into your claims system.”
One of the strongest defenses is maintaining clearinghouse acceptance reports and payer acknowledgment reports. If you can prove the payer received the claim electronically, it becomes much harder for the insurer to deny the claim based on alleged non-receipt or timely filing.
Do you have questions about this article or other billing concerns, then click here to schedule a FREE 15-minute consult with Dr. Marty Kotlar.
Dr. Marty Kotlar is the President of Target Coding. Over the last 12 years, he has helped hundreds of chiropractors, acupuncturists, physical therapists and massage therapists with compliance as it relates to billing, coding, documentation, Medicare & HIPAA. Dr. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance journals and a guest speaker at many state association conventions. He can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – drkotlar@targetcoding.com.
