What are Unresolved Claims?
Un-Resolved is an HYPEMedical tool designed to eliminate stale dated claims.
HYPEMedical defines Un-Resolved as unpaid claims with a service date exceeding six weeks from the current date. The Un-Resolved report will alert you to outstanding claims where the service date is between six weeks and six months from the current date. Operationally these aged claim items are Unpaid or Partially Paid where the claim status is Unsubmitted, Submitted or Rejected.
HYPEMedical's default operational definition for Un-Resolved claim items can be made to include all Claim Types.
Possible reasons for the existence of old unpaid (unresolved) claims may be:
- Recently created with a service date over six weeks
- Accidentally not processed by OHIP as would be expected
- Claims were processed and paid but were not reported on an RA
Track your Unresolved report regularly, especially after every RA processing at the beginning of each month.
With Billing Cycle, edit the claims that require revision and mark the remaining unresolved claims as Unsubmitted.
Edit or Mark As Unsubmitted in bulk or by individual claim.
Tracking previously resubmitted OHIP claims
As you track unresolved claims between revisions, resubmissions and rejections, separating the newly unresolved from the previously resubmitted unresolved claim items may become challenging.
How would you know if and when you resubmitted any unresolved claim items?
Fortunately, HYPEMedical's Billing Cycle makes tracking easy. Before clicking Find on your next "Unresolved" search, checkmark the Last Submitted Date column.
Checkmark the Last Submitted Date column. The Last Submitted Date column.
*Originally published July 31, 2021
I have OHIP claims in September that are still sitting in the submitted status. How do I fix that & how did that happen?
I have looked at your account's Quick Reports on your HYPEMedical's Home page and found 64 Unresolved claims. I clicked on its green icon loading a Billing Cycle report. The same report is accessible directly from Billing Cycle by clicking on the ...
How do I bill OHIP?
Billing OHIP: Click the Claims button in the main menu, search for a patient, and hit Enter. Enter Service codes, and hit Enter. Search or create the next patient, hit Enter, and Go to step #1. Saving a claim for a new patient will also automatically ...
What outcomes can I expect for my claim submission to OHIP?
There are four possible outcomes or scenarios: The Four Scenarios Most OHIP claims follow the ideal billing flow shown in the rightmost flow chart (Best Scenario). In the "Best Scenario" a Claim is entered and saved to the UNSUBMITTED status, then ...
Can I see a patient's billing history as I bill?
Yes, up to 12 month of a patient's billing history is displayed directly on the bottom of the billing form. A patient's complete billing history is displayed one click away in the Patient History tab. The Patient History tab is searchable by date ...
Can I delete a duplicate OHIP/medical claim in HYPEMedical?
Yes, you can; If your user account has the ClaimDelete permission. A duplicate claim occurs when at least one service code for the same service date and health card number exists on two separate claims. Duplicate claims are sometimes allowed in ...