Q&A: When carriers say they haven't received claims

November 7, 2008

Certain insurance carriers insist they are not receiving our claims, regardless of whether they were sent by our online program, fax, or mail. What can we do about this repeated stall tactic?

Q: Certain insurance carriers insist they are not receiving our claims, regardless of whether they were sent by our online program, fax, or mail. What can we do about this repeated stall tactic?

A: There have been numerous claims problems recently with the implementation of the National Provider Identifier. That aside, there could be several other issues affecting claims. Fax and mail tend to be the "black holes" of claim submission. There is no way to track insurer receipt and therefore no way to dispute an assertion that the claims were never received. If claims problems are with one or two specific insurers, contact them to resolve the issue, and if there is no resolution, contact the insurance commissioner in your state to report the problem. Chances are you are not the only practice experiencing this problem. You can also check the American Medical Association's website. It contains information about physicians' rights relating to claims settlements with insurers; go to http://www.ama-assn.org/ama/pub/category/18525.html.