Possible Areas of Medical Claim Rejection and the Best Solutions
Many medical service providers have difficult times dealing with medical claims, and in most cases, the insurance companies reject the claims. 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. You have to realize that making a successful claim is not only your duty but your medical service provider also plays a crucial role. This article outlines some of the common errors that people make when submitting medical claims and the proposed remedies.
Missing information – Insurance companies are thorough in checking claims and in case of any missing information, they will reject 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 claim – If two claims are made to the insurance company on the same day for the same kind of service offered by the medical facility, then the insurance company will deny the claim. This kind of claim submission is not allowable, and the insurance company will reject it. Having a competent team of employees and installing medical billing software can significantly reduce the double claim instances.
Service already settled – In some cases, you can find a provider claiming a service that the insurance company has already settled in another payment initially. Through embracing the latest technology on claim processing, you can avoid the instances of service already adjudicated. You can install claim processing software in your organization but ensure you choose the best one which matches the requirement of the insurance company.
Not covered by payer – A high percentage of claim denials are due to procedures not covered by payers. A patient’s benefit plan outlines the kind of procedures covered under it, and this is a crucial consideration when submitting a claim to an insurance company. It is recommendable to refer to a patient’s benefit plan when preparing a claim or before you offer the services.
Filing date expired – You should note that medical claims have deadlines for submission and you must adhere to them. Late submission of claim can lead to rejection. 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.