Delayed Claims
Delayed Claims worklist shows charges being held that will require additional action before being billed. Charges on this worklist can be released automatically or manually.
- Claims are released automatically when key information is added into the system, like missing authorizations or Provider Credentials. However, claims for Provider Credentialing will only be released if there are no Provider Claim Holds or the Insurance Class no longer has the Provider Credentialing Required checked.
- Claims may need to be released manually when changes are made in the system, such as adding missing demographic information or a miscellaneous clinic hold.
Once claims are released, they'll drop off this report and move to "B" status ( Released Charges) where they will bill overnight.
- Open the Billing menu and select Delayed Claims.
- You can filter this queue by Company, Practice, Location, Claim Delay Reason and Group By. Make your selections and click Search.
- The worklist displays Delay Reasons, 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 Delay Reason link.
- Drilling down in this worklist by clicking on the Patient ID displays 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 for RevEquip Members | Resolution for Self-Service Members |
| Charges for Newly Imported | Contact updates@webpt.com and provide any new procedure codes and their price. | Follow these instructions. |
| Evals missing Functional Reporting Codes | FLR is no longer an insurance requirement. To remove, contact updates@webpt.com. | FLR is no longer an insurance requirement. To remove, contact updates@webpt.com. |
| 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. | 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. |
| 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 edi.help@webpt.com. | Review the Provider information. Ensure that all required (!) fields are updated, specifically Provider Type, First Name, Last Name, Taxonomy Code, NPI, Pri Specialty, and State License Number. |
| Incomplete Code - Procedure | Create an addendum in the WebPT EMR to correct the procedure code and/or contact updates@webpt.com so the code can be reviewed. Updates can remove the claims from delay once necessary updates are made. | Create an addendum in the WebPT EMR to correct the procedure code, or activate the specific procedure code in the Fee Schedule. |
| Invalid Dx Type for payer | Update the insurance in the WebPT EMR to use ICD-10 Dx codes. | Update the insurance in the WebPT EMR to use ICD-10 Dx codes. |
| 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 updates@webpt.com. | 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 updates@webpt.com. |
| Misc Hold by WebPT | Refer to the patient’s Account Note for more information on how to resolve. | Refer to the patient’s Account Note for more information on how to resolve. |
| Misc Hold by Clinic | Release charges when desired. | Release charges when desired. |
| Missing Dem/Ins Info | Refer to the patient’s Account Note for more information on how to resolve. | Refer to the patient’s Account Note for more information on how to resolve. |
| Missing POC date | Add a POC to the charges using Error Corrections. | Add a POC to the charges using Error Corrections. |
| Missing Referring MD NPI | Use the NPPES website to locate the NPI of the Referring Physician. Add it to WebPT Billing. | Use the NPPES website to locate the NPI of the Referring Physician. Add it to WebPT Billing. |
| No Authorization | If an auth is available, verify that the claim on delay is within the date range of the auth and that visits/units are available. Attach through Error Corrections. | If an auth is available, verify that the claim on delay is within the date range of the auth and that visits/units are available. Attach through Error Corrections. |
| Pending Addendum | Provide the addended information to updates@webpt.com. | Once the therapist finalizes the addendum, verify updates via the Charge Updates page. |
| Pending Prov Credentialing | Notify updates@webpt.com once the provider is credentialed. | Release manually once the provider has been credentialed. |
| Provider not Authorized | Contact revequip@webpt.com for more information. | This typically occurs if an assistant is not authorized to treat patients. |
| Therapist not Cert w/ Medicaid | Once obtained, submit your credentials to edi.help@webpt.com. | Update the therapist's profile. |
| Therapist not Cert w/ Medicare | Once obtained, submit your credentials (PTAN) to edi.help@webpt.com. | Update the therapist's profile. |
| Therapist not Cert w/ RR Medicare | Once obtained, submit your credentials to edi.help@webpt.com. | Update the therapist's profile. |
| Therapist not Cert w USDOL | Once obtained, submit your credentials to edi.help@webpt.com. | Update the therapist's profile. |
| Ins Class Code Provider Credentialing | Notify updates@webpt.com once the provider is credentialed. |
Update the therapist's profile to add the Provider’s Credentials. |
| Inactive Charge with Active Payment | Move the payment off of the charge line, then release it from Claim Delay. After the next process runs, a No Charge (NC) needs to be applied. |
Move the payment off of the charge line, then release it from Claim Delay. After the next process runs, a No Charge (NC) needs to be applied |