Which action is appropriate if claims remain unresolved?

When claims remain unresolved, escalating for additional review is the appropriate action. This step is crucial because it helps to ensure that all aspects of the claim are thoroughly examined. An escalation can involve seeking assistance from a supervisor or a specialized department that may have more resources or expertise in resolving complex issues. By pursuing this avenue, you increase the likelihood of addressing any misunderstandings or errors that may have contributed to the delay in processing the claim.

Taking action by escalating the issue shows a proactive approach to managing claims, which is important in a medical insurance setting where timely resolution is essential for maintaining patient satisfaction and ensuring proper reimbursement for services rendered. This contrasts sharply with waiting indefinitely for responses, which is unproductive and can lead to further complications, or closing the case without follow-up, which can leave unresolved issues that may impact the practice's financial health. Additionally, assigning blame to the patient does not facilitate resolution and could damage the patient-provider relationship.