After the claim goes out.

Where payments go missing

Most of the money a small chiropractic practice loses to insurance does not disappear in one dramatic denial. It slips out at the handoffs, where one report ends and the next one starts, and nobody owns the gap between them.

• A claim the clearinghouse rejected for a typo in the subscriber ID. It never reached the payer, so it never appears on a remittance, and nothing reminds anyone about it until the filing deadline has passed.
• A CMT line denied for a missing modifier and posted as a write-off, when a corrected claim could have fixed it.
• A contractual adjustment accepted without a look at the contract, even though the allowed amount came in below your rate.
• A deposit that arrived short because the payer took back an overpayment from a visit last spring, posted as if the full amount had come in.
• A deductible nobody billed, or a balance billed to the patient that belonged to a second payer.

Each of those is visible in a report your practice already receives. These guides show you where to look.

Follow one claim through

Read the guides in order and you follow a single visit from the moment the claim leaves your office to the moment its last dollar has an owner.

1. Accepted or rejected. Within a day or two, the clearinghouse and the payer check the file and the claim before anyone decides payment. A rejection here is not a denial, and it needs a different fix. Read: a rejected claim is not a denied claim.
2. Adjudicated. The payer decides each line and sends its answer as an electronic remittance advice, the ERA. Read: how to read an ERA, line by line.
3. Denied or cut. Every line the payer reduced or refused carries a reason code. The code tells you whether the fix is paperwork or a provider’s judgment. Read: chiropractic denial codes, and what to do with each one.
4. Deposited. The money arrives in your bank as one lump that can cover many claims and many dates. A trace number ties it back to its remittance. Read: match each insurance deposit to the payment behind it.
5. Owed by someone. Whatever the payer did not pay belongs to the patient, to a second payer, to a write-off or to an open question for the payer. Read: what the patient owes after insurance pays.

Who owns each stop

A practice that bills its own claims needs a name next to every stop, not just a person who “does the billing.” Most tasks at stops one through four are administrative: a corrected subscriber ID, a missing modifier, a deposit matched to its remittance. Your office can own all of it.

Some of it is not administrative. When a payer says a visit was not medically necessary, or that the records do not support this many visits, the answer starts with what the signed note supports. That call belongs to your provider. A billing process that mixes those two kinds of work either buries your provider in paperwork or lets someone without clinical authority answer a clinical question.

At stop five, your front desk owns collection. The remittance tells you the amount; your office decides how and when to ask for it.