Claim Delay Summary
This report displays all of the charges that are being held by your clinic or RevFlow. A clinic may hold charges for a patient if the provider is not yet certified with an insurance, like Medicare. RevFlow may hold charges if any information is missing or incorrect. For information on how to hold charges, please see: Charge Audit.
To view the report:
- Navigate to Reports > Audit Reports > Charge Claim Delay Summary.
- Select the desired Company, Practice, and Place of Service.
- Click Run Report.
- The report displays a list of all Delay Descriptions, the number of Charges affected, and the total Charge Amount. To see a breakdown of charges that are delayed for a specific reason, double-click the Details link.
Drilling down on this report will display each service line that has been delayed. You can use the information here to make updates and corrections for the charges to be removed from the report.
- To release charges from this report, take advantage of Release Claim Delay.
Claim Delay Reasons
|Reason||Resolution||Who Can Remove?|
|Charges for Newly Imported||Contact email@example.com and provide any new procedure codes and its price.||Claims Management|
|Evals missing Functional Reporting Codes||FLR is no longer an insurance requirement. To remove, contact firstname.lastname@example.org.||Claims Management|
|Incomplete patient and/or case||Review the patient, responsible party, and case(s). Ensure that all required (!) fields are updated. For employment-related cases, the employer must be listed on the case.||Claims Management|
|Incomplete Code - Provider||Review the Provider information. Ensure that all required (!) fields are updated, specifically Provider Type, First Name, Last Name, Taxonomy Code, NPI, Primary Specialty and State License Number. If any of those fields are blank, contact email@example.com.||Claims Management|
|Invalid Dx Type for payer||Update the insurance to use ICD-10 Dx codes.||Claims Management|
|Invalid Medicare Dx||Review the Local Coverage Determinations (LCDs) for your Medicare carrier to verify that you are using a valid Dx code that supports “Medical Necessity” for the CPT code(s) being billed. If valid, notify firstname.lastname@example.org.||Claims Management|
|Misc Hold by WebPT||Refer to the patient’s Account Note for more information on how to resolve.||Claims Management|
|Misc Hold by Clinic||Release charges when desired.||Claims Management, Member|
|Missing Dem/Ins Info||Refer to the patient’s Account Note for more information on how to resolve.||Claims Management, Member|
|Missing POC date||Add a POC to the charges using Error Corrections.||Claims Management|
|Missing Referring MD NPI||Use the NPPES website to locate the NPI of the Referring Physician. Add it to RevFlow.||Claims Management|
|No Authorization||If an auth is available, very that the claim on delay is within the date range of the auth and that visits/units are available. Attach through Error Corrections.||Claims Management, Member|
|Pending Addendum||Provide the addended information to email@example.com.||Claims Management, Member|
|Pending Prov Credentialing||Notify firstname.lastname@example.org once the provider is credentialed.||Claims Management, Member|
|Provider not Authorized||Assistants are not authorized to treat Tricare patients. Contact your Hub Manager for more information.||N/A|
|Therapist not Cert w/ Medicaid||Once obtained, submit your credentials to email@example.com.||EDI Help|
|Therapist not Cert w/ Medicare||Once obtained, submit your credentials (PTAN) to firstname.lastname@example.org.||EDI Help|
|Therapist not Cert w/ RR Medicare||Once obtained, submit your credentials to email@example.com.||EDI Help|
|Therapist not Cert w USDOL||Once obtained, submit your credentials to firstname.lastname@example.org.||EDI Help|