RESOLTA — CLAIM REVIEW CHECKLIST

Use current payer-specific requirements. Keep patient and claim identifiers in your approved secure system.

[ ] Confirm scope
Identify the payer, program, jurisdiction, service period, claim format and submission route.

[ ] Locate source records
Confirm the required referral, authorization, invoice and service evidence are available in the approved secure system.

[ ] Compare identifiers
Check member and submitting provider identifiers against the appropriate authoritative record.

[ ] Review authorization evidence
Where applicable, compare services, dates and units with the received authorization and current payer instructions.

[ ] Check claim fields
Review required fields, dates, units and modifiers against the applicable claim format and payer rules.

[ ] Verify the rule source
Confirm the program, source section, effective period and any relevant updates.

[ ] Resolve review questions
Have a billing reviewer decide corrections and document any unresolved exceptions.

[ ] Retain transmission evidence
Keep the actual sending confirmation and correlation reference. A generated file is not a submission.

[ ] Read acknowledgments
Identify the sender, status and submission attempt for each response.

[ ] Assign follow-up
Record the next action, owner and payer-specific deadline source in your secure workflow.

[ ] Reconcile remittance and cash
Match claim and line details to the ERA/EOB, then reconcile the bank receipt separately.

[ ] Close with evidence
Confirm the documented outcome before closing an item. Silence alone does not establish denial or payment.

A completed checklist is not payer approval or a guarantee of payment.
https://www.resolta.ai/resources/claim-checklist/