During payer follow-up, the representative says the claim was never received. What would you verify before resubmitting it?

When a payer representative says a claim was never received, the first step should be to verify the original claim transmission rather than immediately resubmitting it.

I would start by reviewing the claim submission history in the billing system and clearinghouse. This includes the original submission date, batch or transmission details, clearinghouse acceptance report, and any payer acknowledgment.

A clearinghouse acceptance only confirms that the clearinghouse accepted the claim. It does not always prove that the payer successfully received and loaded it into its adjudication system. If payer acknowledgment information is available, that provides stronger evidence of receipt.

Next, I would verify the payer ID and claim destination used on the original submission. A claim may have been transmitted successfully but routed to the wrong payer, wrong plan, or incorrect electronic payer ID.

I would also verify:

• Patient name and date of birth
• Member or subscriber ID
• Date of service
• Provider information
• Billed amount
• Correct primary or secondary payer
• Claim type
• Original claim number or tracking number, if available

It is also important to search the payer portal or claim status system before resubmission. Sometimes the claim exists under a different internal claim number, was matched to another member record, or is still processing even though the representative could not initially locate it.

If proof exists that the payer accepted the claim, I would provide the relevant submission or acceptance details and ask the payer to search again or advise on the appropriate next action.

If the payer confirms that the claim truly was not received, I would resubmit it promptly. Depending on the payer and the age of the claim, proof of the original timely submission should be retained in case a timely filing issue occurs later.

The key principle is to avoid blind resubmission. Sending another claim when the original is already in the payer’s system can create a duplicate claim or duplicate denial.

An AR representative contacts a payer about a claim submitted 60 days earlier, and the payer representative says no claim can be found.

The billing system shows that the claim was transmitted successfully, and the clearinghouse report confirms acceptance. The AR representative then checks the payer ID and discovers that the claim was originally sent to a different electronic payer ID associated with another plan.

The correct payer ID is verified, the claim is resubmitted to the proper destination, and the original submission records are retained for documentation.

In this situation, simply resubmitting the original claim without identifying the routing issue would likely have caused the same problem again.