Your clinic has two hours to chase unpaid claims. Which go first?

You have two hours before the clinic gets busy. One insurer owes 120,000 on a recent claim. Another owes 45,000 on a claim that has been sitting unpaid for three months. A third owes just 8,000, but its appeal deadline is tomorrow.

Start with the 8,000 claim. Waiting one more day could cost the clinic its opportunity to challenge the denial. Once you’ve protected that opportunity, use the rest of your time on the overdue 45,000. The 120,000 deserves a status check, but its size alone doesn’t make it urgent.

How to prioritise unpaid insurance claims

For each claim, check three things: how much is still unpaid, how long it has been outstanding, and what changes if you wait until tomorrow. Use the remaining balance after payments and adjustments. Measure age consistently. In the example below, age means days since the clinic submitted the claim.

Then identify what kind of work the claim needs. A claim awaiting payment needs a status check. A denied claim may need a correction, reconsideration or formal appeal, depending on the payer’s instructions. Check the actual notice for the route, deadline and submission requirements before acting. A routine phone enquiry may leave a formal deadline untouched. aetna.com

Three claims, ranked in the order I’d work them

The figures below are fictional and use one local currency. The deadlines and payment terms belong to this example.

1. Claim A — 8,000 unpaid, 24 days old, appeal due tomorrow

The payer denied the claim because it could not match the service to an authorisation. The clinic has the authorisation confirmation. The denial notice gives tomorrow as the appeal deadline.

First, match the authorisation reference, service date and authorised service to the denied claim. If they support the appeal, submit it through the route specified in the notice and save the submission reference and time. If a document or signature is missing, contact the person who can supply it now. Give the case a named owner and a same-day follow-up time.

This claim ranks first because you already have evidence to act on, and tomorrow’s deadline changes what the clinic may be able to recover. An appeal submitted is still an unpaid claim. Keep the 8,000 outstanding until the payer’s decision and any payment have been reconciled.

2. Claim B — 45,000 unpaid, 92 days old, no denial on file

The payer acknowledged receipt. The payment period agreed for this claim has passed. The ledger says “followed up twice,” but neither note explains what is holding up payment.

Start with a question that can move the claim forward: “Has this claim been approved for payment, is it waiting for a document, or has a decision already been issued? Please give me the relevant reference and date.”

Each answer gives you a different next step. If it was paid, obtain the remittance reference and match it to the clinic’s receipts before chasing again. If a document is missing, record exactly what is needed and who will send it. If the payer issued a denial the clinic never received, obtain the notice and check the deadline immediately. That new information could move this claim to the top of the queue.

3. Claim C — 120,000 unpaid, 12 days old, accepted and still within the payment period

This is the largest balance. The payer has acknowledged it, the expected payment date is still ahead, and there is no outstanding request for information.

Confirm those facts, record the expected payment date and set a follow-up for the first working day after it. That gives the clinic control over its largest balance without spending the morning asking for a payment that is not yet overdue. If the acknowledgement is missing or a document request emerges, reassess the priority.

How to spend the two hours

• First 10 minutes: Check payer notices and portal messages for deadlines or document requests that have not reached your ledger.
• Next 40 minutes: Work Claim A. Submit the appeal and save the reference, or escalate the missing requirement while there is still time to act.
• Next 40 minutes: Investigate Claim B. Aim to leave with a payment reference, a specific missing item or a dated escalation.
• Next 15 minutes: Verify Claim C’s acknowledgement and expected payment date. Set the reminder.
• Final 15 minutes: Revisit anything you escalated and update the handover. Record the remaining balance, action taken, reference, next owner and follow-up date.

Those time blocks are a starting point. If Claim A’s records take five minutes to request, send the request immediately and work Claim B while you wait. Keep a reminder to return to A before the day ends.

A five-minute check for your next claims session

Open your unpaid claims list and mark three entries: the nearest verified deadline, the oldest overdue claim with an unexplained balance, and the largest unpaid amount. One claim may fit more than one description.

Beside each, finish this sentence: “Today, ___ will take ___ action by ___ because waiting would ___.” If the entry only says “call insurer,” make it more specific. What answer do you need, and what will you do with it?

That is the difference between a ledger showing “followed up” and a handover your colleague can act on: “Payer confirmed payment on Thursday. Grace will match remittance R104 to the bank receipt by Friday morning.”