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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. Submitting a successful claim is a collective effort that requires the participation of a team of competent employees in the organization. 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. Most people forget to include personal information, the plan code, and security number. Some people feel that other details are not crucial and they leave them out. 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 kind of claim submission is not allowable, and the insurance company will reject it. 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. 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 – 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.

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. However, it is crucial that you submit the claims in time so that even if it is rejected, you have ample time to make corrections and file the claims again before the deadline is due.

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