Possible Areas of Medical Claim Rejection and the Best Solutions
A lot of people are grappling with rejected medical claims, and they are still frustrated because they do not know how to go about the process. Many people make mistakes and errors in submitting claims, and they do not know why the claims get rejected even if they try it severally and for that reason, it is essential that you get conversant with some of the factors which can lead to medical claim rejection by an insurance company. 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 – Insurance companies are thorough in checking claims and in case of any missing information, they will reject it. Most people forget to include personal information, the plan code, and security number. Most people tend to forget filling in the details, and that leads to medical claim denial. Do not rush to fill and submit the form but spare some time to go through the claim form to check whether there are any missing details.
Duplicate claim or service – In some cases, you find that your medical service provider submits a double claim for the same services provided on the same date. This is a duplicate claim and will not go through when the insurance company notices. The medical service provider should invest in qualified staff to prepare the claims to ensure that no duplicate.
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. If you to minimize such instances in your organization, you can install the latest medical billing software which assures accurate processing of claims.
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.
The limit for filing expired – It is essential to submit the medical claims in time before the filing date expires. If you submit the claims late, the insurer will automatically reject it. 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.