Once you clear the basic questions in an AR or billing interview, the operations manager moves to scenarios: "The payer says the claim is not on file. What will you do?" or "The claim shows paid but the provider never received the money." These questions separate candidates who memorised definitions from those who understand the work.
This guide focuses on those practical scenarios, plus claim form and prioritisation questions. For the basics of AR calling, read our AR caller interview questions first.
Claim status scenarios
1. The payer says the claim is not on file (NOF). What will you do?
Check the clearinghouse reports to see whether the claim was accepted by the payer. If it was accepted, give the payer the acceptance details and ask them to locate it or confirm the correct submission route. If it was never received, verify the payer’s claim address or payer ID and resubmit the claim, keeping timely filing in mind.
2. The claim has been "in process" for 45 days.
Ask the payer why it is pending, whether anything is needed (records, itemised bill, information from the patient), the expected processing time and a call reference number. If it is beyond the payer’s normal processing time, ask for escalation, and set a follow-up date.
3. The claim shows paid, but the provider says payment was not received.
Get the payment details: date, amount, check or EFT trace number, and the payee name and address. If the payment was by check and not cashed, request a reissue as per the payer’s process. If it was cashed or the EFT went to the wrong account, request a copy of the cancelled check or a trace, and check for provider address or bank detail issues.
4. The payer requests medical records.
Note exactly which records are needed, the fax number or mailing address, the time limit and the reference number, then coordinate with the provider to send them, and follow up to confirm receipt.
Denial scenarios
5. Denied because the patient’s coverage was terminated.
Verify eligibility on the date of service with the payer. If there is other active insurance, bill it. If not, follow the client’s process to bill the patient and update their insurance information.
6. Denied as a duplicate.
Check whether the original claim was paid, denied or is in process. If the original is still open, follow it up instead. If this was a separate service, correct the claim (for example with an appropriate modifier where supported by documentation) and resubmit or request reprocessing.
7. Denied for missing modifier or bundling.
Send it to the coding team for review. If documentation supports a separate service, correct the modifier and resubmit; otherwise adjust according to the client’s rules.
8. Denied for timely filing, but you believe it was sent on time.
Collect proof of timely filing such as clearinghouse acceptance reports or payer acknowledgement, and appeal with that proof within the appeal deadline.
9. Secondary insurance denied because the primary EOB was not attached.
Obtain the primary payer’s EOB or ERA and resubmit the claim to the secondary with it attached, as per the secondary payer’s requirements.
Payment and posting scenarios
10. The payer paid less than expected.
Check the allowed amount against the fee schedule or contract, look at adjustment codes, and confirm whether patient responsibility or bundling explains the difference. If it is an underpayment, request reprocessing or file an appeal with the contract details.
11. There is a credit balance on a patient account.
Find the cause: overpayment by the payer, duplicate payment, or a patient overpayment. Follow the client’s refund process and the payer’s overpayment rules.
12. The payer has taken back money (recoupment).
Identify which claim the recoupment relates to and why, post it correctly, and decide with the team whether the original claim needs correction, rebilling or an appeal.
Claim form questions (CMS-1500)
| Box | What it contains |
|---|---|
| 1a | Insured’s ID number |
| 2 | Patient’s name |
| 21 | Diagnosis codes (ICD-10-CM) with the ICD indicator |
| 24A | Dates of service |
| 24B | Place of service code |
| 24D | Procedure codes (CPT/HCPCS) and modifiers |
| 24E | Diagnosis pointer linking each service to diagnoses in box 21 |
| 24F | Charges |
| 24J | Rendering provider NPI |
| 25 | Federal tax ID number |
| 33 / 33a | Billing provider information and NPI |
Hospitals use the UB-04 (institutional) instead. Most claims are sent electronically, but the box numbers are still commonly used to describe where information goes.
Prioritisation questions
13. You have 60 claims to work today. How do you prioritise?
Follow the client’s work queue rules first. Generally, claims close to timely filing or appeal deadlines and high-value claims come first, followed by older AR buckets, then the rest. Group claims by payer to reduce call time.
14. What is AR ageing, and why does it matter?
It groups unpaid claims by how long they have been outstanding (for example 0–30, 31–60, 61–90, 90+ days). Older claims are harder to collect and closer to deadlines, so ageing guides prioritisation.
The call notes checklist
Interviewers often ask, "What will you note after a call?" A complete answer:
- Date, payer, phone number or portal used, representative’s name, call reference number
- Claim number, date of service, billed amount, claim status
- Payment details if paid (date, amount, check or EFT number)
- Denial reason and code if denied
- Action required, where to send documents, time limits
- Next follow-up date
Frequently Asked Questions
What scenario questions are asked in AR calling interviews?
Common scenarios include claims not on file, claims pending too long, paid claims not received, records requests, eligibility terminations, duplicates, bundling denials, timely filing and secondary insurance denials.
What should I do if a claim is not on file?
Check clearinghouse reports for payer acceptance, share acceptance details with the payer if available, otherwise verify the payer address or ID and resubmit within timely filing.
What is box 24J on the CMS-1500?
Box 24J contains the rendering provider’s NPI for each service line.
How do you prioritise AR follow-up?
Follow client rules, and generally prioritise claims nearing timely filing or appeal deadlines, high-value claims and older ageing buckets, grouped by payer.
What details should be noted after a payer call?
Representative name, call reference number, claim status, payment or denial details, required actions, deadlines and the next follow-up date.