Primary Insurance Responsible

Insurance Responsibility Reports:
The responsibility reports list all the necessary information in a concise format to do the follow-up work on the unpaid claims. Reports “3a,b,c Insurance Responsibility” are basically the same; Report 3a is for the Primary insurance company, Report 3b is for the Secondary insurance company, and Report 3c is for the Tertiary insurance company. Each report lists details of the claims that have been sent to the insurance company AND the insurance company has NOT responded. (In other words-- the insurance company owes on the claims). The reports list the code, name, phone number, contact person, and city of the insurance company. The name, policy number, group number, social security number and DOB are listed for each policy holder. The name, social security number and DOB of the patient are listed if the patient is not the policy holder (such as spouse or child). The initial billing date, last billing date, date of service, procedure code, amount of the charge, and total amount of the claim are listed. At the end of the report is the total amount of all claims in the report. See the Sample Report 3.

The data are first grouped by insurance company then by policy holder then by claim. This
organization makes discussing all outstanding claims with the insurer easy and all inclusive. All the necessary information to call and discuss ALL outstanding claims with an insurer are together in one easy to follow report.

The data selection filters for these reports are:
1) Primary (Secondary, Tertiary) Billing Date is BEFORE (this is the last date the claim was sent)
2) Service Date range
3) Insurance Carrier range.
4) Attending Provider
These filters enable the reports to be very specific; thus, saving time by NOT having to sort
through pages of irrelevant data. It is suggested to use a Primary (Secondary, Tertiary) billing
date of 30 days prior to the current date and no other filters. This will pull all unpaid claims that have been sent to the insurance company more than 30 days ago. The ’30 day filter’ should be used for all three reports since it is the number of days since the claim has been sent to the specific insurance (Primary, Secondary, or Tertiary) company. Insurance companies generally respond within 30 days unless there are problems. The sooner problems are known the better the chance of resolving them. Practices with very old outstanding claims can use the Service Date range in combination with the Primary Billing Date to limit the report to charges that should be followed up. The Insurance Carrier range is used if only a single or range of carriers is of interest. The Attending Provider filter works exactly like in Reports 1 & 2.