Definition of a Claim Status Inquiry

Processing insurance claims is a complex undertaking that can prevent customers and service providers from receiving their money, or receiving a prompt decision on the validity of a claim. As a form of customer service, insurance companies may provide the option for claim status inquiries, which allow customers and service providers to get the answers they need to conduct their business.

Description

• A claim status is a formal inquiry that seeks to determine the standing, or status, of an insurance claim. Customers can make claim status inquiries to learn about whether an insurance company approved or denied a claim, and the reason for denial, if applicable. They can also track the amount of a claim and see an estimated date of payment once a claim is in the later stages of processing. Service providers make claim status inquiries to determine the status of payment from an insurance company for service that a customer received under an insurance policy and did not pay for at the time of fulfillment.

Types

• Claim status inquiries exist across different types of insurance. Health insurance claim status inquiries are common, with doctors' offices, hospitals and pharmacies among the service providers who make use of them. Auto insurance and homeowners insurance companies also allow their customers and member service providers to make claim status inquiries through a customer service department or member relations department. Governments that supply liability insurance programs also offer the option of claim status inquiries to their policyholders.

Methods

• Customers and providers can initiate claim status inquiries by phone, fax or over the Internet, depending on an insurance company's policies. Service providers who make frequent claim status inquiries can usually subscribe to a status inquiry service, which provides online access to all of a provider's current and recent claims with the insurer. Since insurance income is a major source of revenue for health care facilities such as hospitals, subscribing to a claim status inquiry service is an essential part of tracking finances.

Requirements

• To make a claim status inquiry, a customer or provider needs some basic information about the claim. This includes a claim number, which the insurance company issues upon receipt of a claim over the phone, online or by an agent in person. Customers who seek claim status inquiries will also need to provide their account numbers. Online claim status systems may function at all times, though telephone systems may only operate during a customer service department's hours of operation during the business day.