Claim Resolution/Payment Verification Policy

Organizations can use this policy to ensure that claims submitted to third parties for services administered are estimated accurately and resolved in a timely manner.

In this sample, all managed care contract rates and Medicare rates should follow an established procedure for accurate, complete and timely entry into tools used to re-price claims, according to established contract rates and estimated actual claim reimbursement. Denials, appeals, write-offs, underpayments, refunds, etc. should be appropriately handled in a complete, accurate and timely manner. Individuals responsible for resolving the company’s claims should follow an established and standardized procedure outlining follow-up activities related to claim resolution.