01
Verify the applicable requirement
Identify the payer, program, contract, claim type, service context, original or corrected status, and the current source defining the filing requirement. Record the source, effective context, and date verified rather than relying on a universal deadline.
Choose an internal escalation date that protects the external requirement and explain the convention used. Internal targets should not be represented as payer rules.
- 1Identify the controlling source and context.
- 2Record the calculation convention and verified deadline.
- 3Assign an internal warning and escalation owner.
02
Capture the original submission
Retain the exact claim version, destination, channel, submission timestamp, batch and transaction identifiers, and the first authoritative receipt or acknowledgment. A claim-created date alone does not prove delivery.
Keep claim-specific evidence in the approved secured system. Use a non-PHI evidence reference in any operational register.
03
Preserve rejection and response history
Record clearinghouse and payer responses at their actual level and timestamp. Distinguish transport success, file acceptance, claim acceptance, rejection, adjudication, and requests for information.
If a response is missing, follow the documented channel procedure, protect the deadline, and preserve contact or escalation evidence without submitting an unsupported duplicate.
04
Connect corrections and resubmissions
Link each new version to the original, record why the change was supported, and retain the applicable replacement, void, resubmission, or other reference. Preserve both accepted and rejected attempts.
Where a payer provides a specific reconsideration or proof path, retain the current instructions and the material submitted through the approved channel.
05
Monitor risk and test retrieval
Review approaching internal and external dates, missing responses, held claims, and evidence gaps. Assign one current owner and next action for every exposed item.
Periodically retrieve a sample evidence package. The control is not reliable if records exist but cannot be connected quickly to the exact claim and requirement.
- 1Review exposed claims on a defined cadence.
- 2Escalate missing evidence before the deadline.
- 3Test retrieval and correct retention gaps.
