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 highlights some of the mistakes made during medical insurance claim and how you can go about them.
Missing information – Before an insurance company accepts a claim, it goes through the details submitted to it. Vital information on the claim form might include demographic details, plan code and social security number. 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 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 – A high percentage of claim denials are due to procedures not covered by payers. 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. It is recommendable to refer to a patient’s benefit plan when preparing a claim or before you offer the services.
The limit for filing expired – It is essential to submit the medical claims in time before the filing date expires. 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.