Study: My Understanding of Claims

Reasons for Medical Claim Rejection and How to Avoid Them

Many medical service providers have difficult times dealing with medical claims, and in most cases, the insurance companies reject the claims. This is a prevalent problem bedeviling many health facilities in the recent times, and that can lead to inconvenience if the facilities cannot get the money in time for their operations. Submitting a successful claim is a collective effort that requires the participation of a team of competent employees in the organization. This article gives you the possible areas of medical claim rejection and the best solutions to adopt.

Missing information – Before an insurance company accepts a claim, it goes through the details submitted to it. Suppose any bit of information is missing from the claim form, then there are high rejection chances. If any of the details lack on the claim form, the insurer will deny the claim. You can avoid this mistake by double checking the claim form to ensure that every field is duly filled.

Double service or claim – It is possible to come across a scenario where the medical service provider submits two similar claims on the same date about a particular service. This is a duplicate claim and will not go through when the insurance company notices. To minimize the error of duplicate claim, the provider should train the employees to check the claims form thoroughly before forwarding them to the insurance company.

Service already settled – In some cases, an insurer can settle a claim for a different payment, and that can lead to rejection of the current claim. This situation can arise if the provider does not organize the claims in an orderly manner. There is the latest software for processing medical claims, and if you choose the best one, you will not have this problem.

Not covered by payer – Sometimes, medical facilities make claims for medical procedures that were not outlined in a patient’s benefit plan. It is essential that the medical facility gets it right about patients’ benefit plan before claiming because anything outside that will be rejected. The best remedy for this problem is to confirm the insurance eligibility response or even calling the insurer before you give the services.

Deadline for claim submission – Usually, the medical claims have deadlines for submission, and you must note them. If you do not submit the claims at the right time, then the insurer can reject them. Doing everything within time is important so that you can make any corrections if the claim is rejected and fast processing is possible through embracing technology.

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