A professionally structured Claims Follow-Up SOP designed to support consistent, compliant, and auditable insurance claims follow-up across healthcare billing and revenue cycle operations.

This document provides a standardized framework for tracking, monitoring, escalating, and closing insurance claims after submission—without relying on payer-specific rules or proprietary systems.

What This SOP Is Designed For

This Claims Follow-Up SOP is intended for healthcare organizations that need a clear, repeatable process for managing open insurance claims, reducing accounts receivable aging, and improving documentation quality across billing teams.

It is suitable for use by:

• Medical practices and provider groups
• Billing and revenue cycle departments
• Independent billing companies
• Practice managers and revenue cycle leaders

This SOP is payer-agnostic, meaning it can be used across commercial insurance, Medicare, Medicaid, and secondary payers without modification to payer-specific billing rules.

What’s Included

This product includes a fully editable Claims Follow-Up Standard Operating Procedure delivered in both formats below:

• Microsoft Word (.DOCX)
• Adobe-editable PDF

The SOP is structured for immediate internal use and customization.

SOP Coverage Overview

This Claims Follow-Up SOP outlines a complete post-submission claims workflow, including:

• Claim follow-up purpose, scope, and operational boundaries
• Defined roles and responsibilities for billing staff and supervisors
• Standardized claim follow-up timelines and aging thresholds
• Universal claim status categories with required actions
• Step-by-step claims follow-up workflow
• Escalation triggers and escalation levels
• Documentation and tracking requirements
• Claim resolution and closure standards
• Quality control and SOP maintenance guidelines
• Records retention and data handling considerations

The SOP is written using enterprise-level language suitable for internal audits, onboarding, and operational governance.

Key Benefits

• Establishes a consistent claims follow-up process across your organization
• Reduces variability in payer follow-up practices
• Supports improved documentation and audit readiness
• Helps prevent missed follow-ups and aging claims
• Provides clear escalation criteria for unresolved claims
• Designed for scalability across specialties and payer mixes

Editable & Customizable

This SOP is designed to be customized for your organization. You may:

• Update branding and headers
• Modify internal roles or timelines
• Align with existing policies and workflows
• Use digitally or print for internal reference

No proprietary software or system integration is required.

What This SOP Is Not

To ensure compliance and clarity, this SOP does not:

• Provide payer-specific billing instructions
• Offer medical coding or clinical guidance
• Guarantee claim payment or reimbursement
• Replace payer contracts or organizational policies

This SOP is intended as operational guidance only and must be used in conjunction with applicable payer requirements and internal compliance policies.

Ideal Use Cases

• Standardizing claims follow-up across billing staff
• Training new billing or AR team members
• Supporting internal audits and quality reviews
• Improving follow-up consistency for aging claims
• Creating a documented escalation process

File Delivery

• Instant digital download
• Editable Word document
• Editable PDF
• No physical product shipped