A report full of codes, and nobody's name on it
Each week the practice management system shows the status of submitted claims. Most are fine. A handful come back with an error or a query: a missing exemption detail, a date that does not fit, a patient identifier that does not match, a course that overlaps another. The list is long enough to be annoying and short enough to leave for later.
Later comes. Some claims need the dentist to confirm something, some need the patient to bring evidence, and some are simply a typo. They all look the same in the report.
Practices with several performers and a mix of full-time and part-time reception staff find it hardest, because nobody sees the whole list regularly and each person assumes the older items are someone else's.
Why claim problems linger
- Error messages are terse and reception staff are not always sure what they mean.
- Fixes need someone else: a clinician, a patient or the practice manager.
- The report shows the current state, not how long each claim has been stuck.
- Nobody is assigned, so everybody assumes someone else is on it.
- The same mistakes repeat because nobody sees the pattern.
What unresolved claims cost
An unresolved claim is activity the practice delivered and may not be credited for. Beyond the money and the contract figures, the repeated errors point to a process problem at the desk or in surgery that keeps creating the same work. Without a view of causes, the practice fixes symptoms one at a time.
Time matters too. The longer a claim sits, the harder it is to fix: the patient is harder to reach for evidence, the performer has forgotten the detail of the course, and there may be time limits on resubmission under the rules that apply to you. A queue that shows age makes old items stand out.
The claims queue we build
- Submission results are read from your practice management system on a schedule.
- Each problem claim becomes an item in a queue, with the patient, performer, course dates and the error.
- Errors are translated into plain instructions using a lookup your team can edit, for example 'exemption type recorded but no evidence noted'.
- Items are assigned by type: data entry to reception, clinical queries to the performer, evidence to reception with a patient message ready to send.
- Each item shows its age and a target date your practice sets for resolving it.
- When a corrected claim is resubmitted and accepted, the item closes automatically.
- A monthly summary groups problems by cause and by where they started, so training or form changes can target the real source.
| Type of problem | Usually fixed by | What the queue provides |
|---|---|---|
| Patient details mismatch | Reception | Fields to check and compare |
| Exemption evidence | Reception and patient | Message template to request it |
| Clinical data query | Performer | The course and what is being asked |
| Overlapping courses | Practice manager | Both courses side by side |
We do not interpret NHS rules for you. The instructions in the lookup are written and approved by your practice.
Claims admin with an owner
Every claim problem has a name next to it and an age. Performers get only the questions that need them. The practice manager reviews the queue weekly in a few minutes and can see whether it is growing. Over a few months the cause summary tends to show where the same error keeps being made, which is where the lasting fix is.
New reception staff benefit most. Instead of learning claim errors by trial and error, they get a plain instruction attached to each problem and can see how similar ones were resolved before.
Recognise this at your practice?
- Rejected or queried claims sit in a report for weeks.
- Nobody is clearly responsible for fixing them.
- Staff are not sure what some errors mean.
- The same kinds of error keep coming back.