This guide helps you turn an unresolved balance into a clear follow-up: what the payer confirmed, what needs to happen next, and when to check again. It also gives the next person enough context to continue without repeating the same call.
Open the claim and current balance
Use your authorised billing access to open the insurer's invoices. Select the invoice you want to review and confirm its service date, current balance and relationship to the claim. Jane's Credits and Owings guide documents the insurer invoice area and its outstanding invoices and credits.
Read the existing follow-up notes and check for payments, adjustments, credits or a resubmission. If your clinic uses an external biller or payer portal, review those approved records too. Jane may not contain the latest payer response.
Confirm who is responsible for the balance and whether another team member is already handling it. If the invoice no longer needs follow-up, record that finding. The unpaid-bills guide covers the broader payment and credit check.
Use the claim's latest verified status and the payer's documented process. A due follow-up, an unresolved response or a missed expected milestone may justify contact. A claim still within a confirmed processing period may instead need a dated recheck.
Where a payer deadline applies, confirm it in the relevant payer instructions and record it. This guide does not set a universal processing time, resubmission interval or appeal deadline.
Keep patient and claim information in approved systems and channels. Share only the details needed for the authorised billing task.
Ask questions that establish the next step
Adapt these questions to the payer's process:
- Has the claim been received, and what is its current status?
- Is anything missing or incorrect? What exactly is required, and how should it be supplied?
- Is there an existing payment or remittance to reconcile?
- If processing is ongoing, what is the appropriate next review point?
- What reference should the clinic use when following up again?
These are suggested questions, not a Jane feature or a guarantee of the payer's response. Follow your clinic's approved communication process.
Match the response to the next action
| What you verify | What to do next |
|---|
| A payment has already been issued or received | Reconcile the payment and remittance with the correct invoice before requesting payment again. |
| Information is missing or incorrect | Confirm the requirement, assign the authorised correction or response, and record the next review date. |
| The claim is still processing | Record the payer's status and an appropriate recheck based on the actual process. |
| The claim is denied, disputed or responsibility is unclear | Assign it to the person who can review the reason and the payer's applicable process. Resolve responsibility before patient contact. |
| No response was obtained |
Avoid resubmitting simply because a claim is unpaid. Confirm whether a correction, additional information, reconciliation or further review is actually needed.
Record a useful note
Use the clinic's approved claim or billing record:
Claim and invoice: [internal reference and service date]
Checked on: [date]
Latest status: [verified status and source]
Payer response: [confirmed information and reference, where applicable]
Balance checked: [current amount and any reconciliation still needed]
Next action: [specific next step, or no further action and why]
Owner and review date: [person and date]
Keep contact attempts distinct from claim outcomes. Use only the clinical detail needed for the approved billing process.
If your clinic uses Jane claim tasks, its claim task guide shows how a claim note can be assigned as a task with a due date. Use that existing workflow where appropriate.
Close the loop
Invented example: a biller confirms that the payer needs additional information. The note identifies the requirement, who will respond and when the team will check again. The next review records the response that was sent and the payer's latest status. The claim remains open until the result is verified.
A useful follow-up leaves the claim easier to resolve. The next person should be able to see what the payer said, what remains to be done and when to check again. A call, note or completed task shows that work happened; it does not prove the claim was paid. Confirm a payment in the relevant billing records before describing it as received.
Bring unresolved items into the team's weekly Jane review. If the next review shows no further action is appropriate, record why.
Sources
Official Jane guides checked October 12, 2026:
The payer questions, response table and invented example are Caretrics' editorial guidance. Follow the applicable payer instructions and your clinic's approved billing process.
Rob SaricCo-founder & CEO at Caretrics