A Quick Rundown of Medical

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. This is a prevalent problem bedeviling many health facilities in the recent times, and that can lead to inconvenience if the facilities cannot get the money in time for their operations. 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 details – Most insurers are keen on checking details on the claim form submitted to them by the medical service provider, and if any omission is present, 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. Ensure that you counter-check the forms to ensure that everything is well captured.

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 scenario is known as double insurance, and it is a common occurrence if the medical service provider is not keen. Having a competent team of employees and installing medical billing software can significantly reduce the double claim instances.

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. If the provider makes a mistake of claiming the service that is not in a patient’s benefit plan, then the insurer will turn it down. The best remedy for this problem is to confirm the insurance eligibility response or even calling the insurer before you give the services.

Deadline for claim submission – Usually, the medical claims have deadlines for submission, and you must note 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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