What is an Aging Unpaid Claim?

An Aging Unpaid claim is a claim that does not have a matching 835 file/remittance.

The Aging Unpaid Claims report in OneQ provides a list of prescriptions that do not have a matching remittance. This doesn’t necessarily mean you haven’t been paid; only that we haven’t received a remittance yet in order to reconcile these claims.

Claims that fall into the 0 - 30 and/or 31- 60 day range are new claims awaiting the matching remittances.

Claims that fall into the 60 - 90-day range and/or >90 days are claims where we have not received a remittance in a timely manner and these claims need to be investigated. Typical reasons for a delay in receiving remittances for these claims include, but are not limited to, the following:

• APCI Choice is unable to receive remittances from a particular payer, e.g., Express Scripts.
• APCI Choice is not receiving your remittances from a particular payer; however, we have the ability to request this information from the payer.
• A claim that is submitted and then reversed on a different day is the number one reason for claims not having a matching remittance. These claims will never have a matching remittance and must be reconciled manually.

To get the most value from the ResolveRx reconciliation program, it is extremely important to monitor your Aging Unpaid Claims and to verify your payments on a regular cadence.