It can be quite disheartening to have your medical claim rejected for various reasons when you are in need of it. Unfortunately, this problem is common in the recent times, and perhaps, it is high time that you know some of the mistakes made by people during medical claims and how you can avoid such mistakes to make a successful claim. You must not continue receiving high medical claim rejections, and it is time that you learned the mistakes that result in claim denial and how you can rectify them. This article highlights some of the mistakes made during medical insurance claim and how you can go about them.
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. Ensure that you counter-check the forms to ensure that everything is well captured.
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 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. If you have the right medical billing systems in your organization, then you can avoid claim rejections of this nature. 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.
Filing date expired – You should note that medical claims have deadlines for submission and you must adhere to 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.