What are Unresolved Claims?

The Unresolved are unpaid claim items (service codes) with a service date exceeding six weeks from their service date.

Definition: Un-Resolved (Unresolved) Claims in HYPEMedical

In HYPEMedical, Un-Resolved (or Unresolved) items are:

• Unpaid claim items (service codes)

• Where the service date is more than 6 weeks old

• And less than 6 months from the service date

The Un-Resolved tool is designed to help you find and clear “stale-dated” claims before they become too old to pursue.

Summary

• Un-Resolved = unpaid claim items older than 6 weeks

• The Un-Resolved report shows unpaid services with dates between 6 weeks and 6 months old

• Use this report regularly to identify and follow up on outstanding claims
  

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 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:

1. Recently created with a service date over six weeks
   
2. Accidentally not processed by OHIP as would be expected
   
3. 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

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