Approved to Pay

Scenario Occurrences:

• This scenario occurs when the claim is finalized to pay but the payment is not released yet.

On Call Scenario:
                                                                     Approved to pay
                                                                                         ↓
                                                                     What is the processed date?
                                                                                         ↓  
                                                     What are the allowed amount, paid amount and
                                           patient responsibility (Coins, Deductible, or Co-payment)?

                                                                                         ↓
                                      Verify sum of PA and Patient Responsibility(PTR) equals to AA, 
                                             if not then probe the rep and get the correct information

                                                   Click here to validate payment information
                                                                                         ↓       
                                                             When can we expect the payment?
                                                                                         ↓
                                                              May I have the claim# & Call ref#


Important Notes & Actions:

• Please take action as per your process update. Below actions can be different from your process update.
• If the claim is approved to pay and the rep has provided the expected days for payment then you should set the follow-up for that much time.
• Sometimes, when insurance is located in IL state, we come across this scenario while working on a few insurances where insurances usually take 50-60 weeks to release the payment.
• Click here to go to Quiz

Prepare Notes:

Source of Status:

* Call Website

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Processed Date:

*

Allowed Amount:

*

Paid Amount:

*

Deductible Amount:

*

Coinsurance:

*

Copayment:

*

Time to Expect Payment:

*

Additional Comment:

Claim Number:

*

Call Reference#

*



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