ASG Perspectives

Cleaning up on Claims: The Clean Claim Checklist

Monday, November 02, 2015

by April St. Cyr, Claims Manager

At ASG we call a claim a “clean claim” when it has everything we need to begin processing the claim. That sounds simple enough, and our clients are usually great about covering all the important bases. For our part, we strive to achieve a 10-day turnaround from the time a claim is received until the time a check is issued.

In fact, our team is proud to report that in 2015, ASG averaged a 4.5 day turnaround for claims! 

In an ongoing effort to work in concert with our partners, we feel it’s important to prioritize all Advance Funding requests. We also do our best to work with the TPA on a request that has a required payment timeframe due to negotiated discount.

ASG is committed to providing the highest quality services and delivering products that allow our TPA partners’ clients to control costs. To help us continually improve the effectiveness and efficiency of the claims process, be sure to include all of the items on the following Clean Claim Checklist When preparing to submit a claim.

Clean Claim Checklist

-Eligibility

-UB and itemization for all claims over $75,000

-Applicable precerts

-Paid claims report

-Case management notes

-Proof of deductible and out of pocket

-Eligibility inquiry (completed by employer)

-Specific reimbursement form

Click here to download our complete Claims Manual.

Missing information

As we all know, it is sometimes difficult to submit everything with the initial filing of the claim. Be assured that ASG will process the claim and follow up with the TPA every week for missing information. It is important to get the required information to us as soon as possible so we can issue a check. Once the missing information is received and everything is in order, we’ll review and release for a claim.

Check processing

We schedule a check run for claims once a week. If more convenient, ASG also offers ACH (wire) transfers of claim payments in place of sending a check.

April St. Cyr brings 16 years of experience in the MGU/health insurance business and four years in employee benefits to her role as ASG Risk Management’s Claims Manager. Formerly our Claims Analyst, April finds the ever-changing insurance industry interesting and full of learning potential. She attended Husson College and graduated with a BS in Business Administration.

 

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