Insurance update and rebill

How do we get the right insurance from the patient when a claim denies for coverage, verify it, and rebill the claim before the timely filing limit?

Turn the coverage denial into one request to the patient with the filing clock on it. When a claim denies for coverage (not eligible on the date, a terminated plan, a different payer, a member not found), Callvu prefills the encounter, the claim, the denial reason and the coverage on file, asks the patient on their phone for the right insurance with a photo of the card and the subscriber details, verifies the new coverage through the eligibility check for the service date, chases the patient on a clock set from the payer's timely filing limit, routes an unresolved case to patient accounts in the Decision Desk (self-pay conversion, financial assistance, a write-off), updates the coverage in the billing system and the EHR, and rebills the claim to the right payer with the original denial referenced.

In scopeComplex: multi-party handoffsCallvu moves: prefill, chase and verify, write back

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Last updated November 7, 2026.

The problem today

The claim denied in February for a plan that had ended in December; the patient was asked for the new card in June; the new payer's filing limit had passed in May.

Today, without Callvu

Coverage denials are the most curable denial and the most often lost. The patient changed jobs or plans and nobody asked; the claim went to the old payer and denied; the denial sat in a work queue; the request for the new card went by letter; by the time the right payer was billed, its timely filing limit had passed and the balance became the patient's or a write-off.

Each payer has a timely filing limit from the service date or the denial (commonly 90 days to a year); the new coverage must be verified for the service date, not today; the coverage on the account and in the EHR must be corrected so the next claim does not repeat the denial; and the rebill must reference the original claim where the payer requires. The patient is the only source of the new card, and they will answer a text in minutes and a letter in weeks.

A coverage denial handled as a text with a clock is a paid claim; handled as a queue it is bad debt.

How it runs

From the requestto the system of record.

A claim denies or rejects for a coverage reason in the billing system. Callvu opens the case with the encounter, the denial and the filing clock.

Patient or guarantor: Provides the right insurance with a card photo and the subscriber details on their phone.
Patient accounts: Decides unresolved cases in the Decision Desk.
Callvu: Prefills, requests, verifies, chases on the filing clock, routes, updates and rebills.

Prefill and request
The encounter, the claim, the denial reason code, the coverage on file and the payer's timely filing limit from the service date or the denial are prefilled; the patient is asked on their phone, in plain terms, for the insurance that covered the service date, with a photo of the card's front and back and the subscriber's name and date of birth, and told why.
Chase and verify
The card is read on arrival (the payer, the member and group identifiers, the plan type), the new coverage is verified through the eligibility check for the service date and the service type, and a plan that was not active on the date, a coordination of benefits order, or a member mismatch is put back to the patient with the specifics; the chase runs on a clock that works back from the filing limit with reminders.
Decide unresolved cases
A verified coverage proceeds by rule; a patient who does not respond before the clock's threshold, a coverage that was not active, or a secondary-only coverage goes to patient accounts in the Decision Desk with the case and only the allowed outcomes: convert to self-pay with the good faith estimate and the assistance screening, refer to financial assistance, bill the secondary, or write off under the policy.
Write back and rebill
The coverage is corrected on the account in the billing system and in the EHR's registration record (so future claims go to the right payer), the claim is rebilled to the right payer with the original claim and denial referenced where the payer requires, the filing is logged with its date against the limit, and the denial is logged by cause for the front-end prevention report.

Where it ends: The right coverage came from the patient in a text, was verified for the service date, corrected on the account and the EHR, and the claim was rebilled before the filing limit, with the denial logged for prevention. The Decision Trace shows the denial, the verification and any decision; the Audit Trace shows the request, the card, the chases and the rebill with time.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

Payer timely filing limits and corrected claim rules (Medicare's 12-month limit under 42 CFR 424.44, Medicaid and commercial contract limits): Medicare claims must be filed within one calendar year of the service date; commercial and Medicaid payers set their own limits from the service date or the denial (commonly 90 to 180 days for a corrected claim), and a claim filed late is denied with no appeal, so the rebill is scheduled against the limit.
HIPAA eligibility transactions (270 and 271) and the coordination of benefits rules: The new coverage is verified through the standard eligibility transaction for the service date, and the order of benefits (primary and secondary) follows the payers' coordination of benefits rules, which the rebill respects.
Medicare Secondary Payer rules (42 CFR 411) and the hospital's self-pay conversion and assistance policies: Where Medicare is involved, the questionnaire and the primary payer determination apply; where no coverage is found, the account converts to self-pay under the policy with the good faith estimate and the financial assistance screening the rules require.

Company policies

A coverage denial becomes a request to the patient the day it posts, with the filing clock on the case.
New coverage is verified for the service date before the rebill, never assumed from the card.
The coverage is corrected on the account and in the EHR so the denial does not repeat.
The billing system is the system of record for the coverage, the rebill and the denial log.

Controls

Denial prefill with the filing clock.
Patient request with card photo and reading.
Eligibility verification for the service date.
Chase working back from the filing limit.
Decision Desk for unresolved cases.
Coverage update, rebill with reference and denial logging.

Clocks and deadlines

Timely filing: The payer's limit from the service date or the denial, on the case; the chase and the rebill are scheduled against it.
Patient response: Reminders on the policy's schedule with a threshold before the Decision Desk.

Documents and checks

The claim, the denial and the coverage on file
The card images and the subscriber details
The eligibility response for the service date
The decision where one was needed
The coverage update, the rebill and the log

In the Decision Trace

The denial reason and the verification result.
Any decision and the person.

In the Audit Trace

The request and each chase with time.
The card and the verification with time.
The update and the rebill with the filing date.

The handoff

Between the front doorand the back office.

The front door

The patient on their phone, from a text or the portal.

The back office

Patient accounts decides only unresolved cases; the rebill and the registration update run from the verification.

The Decision Desk

A non-responsive patient near the filing threshold, a coverage not active on the date, or a secondary-only coverage goes to patient accounts in the Decision Desk with the case and only self-pay conversion, financial assistance referral, bill the secondary, or write off under the policy.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

23 hospitals in the Ministry of Health network run on Callvu.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

How is the patient asked?

By text or portal message the day the denial posts, for the insurance that covered the service date, with a photo of the card and the subscriber details, and told why.

How is the new coverage checked?

Through the eligibility transaction for the service date and the service type, not for today; a plan that was not active on the date goes back to the patient with the specifics.

What about the filing limit?

The payer's limit is on the case from the denial, the chase works back from it, and the rebill is logged with its date against the limit.

Related processes

Insurance eligibility verification Coordination of benefits updates Claim denial appeals Financial assistance applications Try it in the sandbox All healthcare processes

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