According to Medicare guidelines, what should a provider do if a claim has not been paid after thirty days?

According to Medicare guidelines, if a provider has not received payment for a claim after thirty days, the appropriate next step is to contact the payer using the telephone or electronic claim status inquiry. This action is essential for clarifying the status of the claim and determining whether there are any issues that need to be resolved or if additional information is required from the provider.

By reaching out to the payer, the provider can obtain specific details about the claim's status, including whether it is still pending, if it has been denied, or if there are any outstanding documentation or appeals necessary for processing. This proactive approach ensures that any problems can be addressed promptly, reducing the time it takes to resolve payment issues and ultimately supporting better cash flow for the provider's practice.

Waiting another thirty days before making a contact or assuming the claim was denied does not address the issue in a timely manner, and simply filing a new claim could lead to duplicate submissions, further complicating the payment process. Therefore, contacting the payer is the most effective way to handle unresolved claims.