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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. 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 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. Vital information on the claim form might include demographic details, plan code and social security number. Some people feel that other details are not crucial and they leave them out. Ensure that you counter-check the forms to ensure that everything is well captured.

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 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, 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. 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 – A high percentage of claim denials are due to procedures not covered by payers. 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. It is advisable to submit the claims in the right time so that you can have an opportunity to revise them if there is any denial and you can count on technology to prepare and submit the medical claims quickly.

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