How to reply to a TPA query so it is closed the first time
A good query reply answers exactly what was asked, attaches exactly what was asked for, and goes out the same day.
Every query reply that needs a second round adds a week or more to the claim. Most second rounds happen because the reply did not answer the question that was actually asked.
Read the query twice
Queries are short and written in a hurry. Before replying, list each thing being asked for. A single line often asks for two documents.
Reply in the same order
- Quote the claim number, patient name and policy number in the subject.
- Answer each point in the order it was asked, numbered.
- Attach each document named in the query, and name the files clearly.
- If something does not exist, say so plainly and give the reason, signed by the treating doctor where needed.
Same day, every time
Set a rule that every query is answered within the day it arrives. Older queries should be reviewed every morning.
Learn from every query
Keep a log of queries by payer and reason. If the same query keeps coming back, add that check to your file checklist so it is caught before the file is sent next time.
Let software do the reading
Ekline Claims reads TPA emails as they arrive, links each query to the right patient, and drafts the reply with the documents already in the file, ready for the desk to check and send.
More from the blog
Documents required for a cashless claim: the complete hospital checklist
The documents insurers and TPAs ask for most often, grouped by the desk that owns them, so nothing is missing when the file is sent.
Cashless claim process in a hospital: a step-by-step guide for the TPA desk
From the patient at the admission counter to the money in the hospital account: the eight steps of a cashless claim, and where each one goes wrong.