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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 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. 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. Do not rush to fill and submit the form but spare some time to go through the claim form to check whether there are any missing details.

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 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, 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. You can install claim processing software in your organization but ensure you choose the best one which matches the requirement of the insurance company.

Services not in the payer’s benefit plan – A patient’s benefit plan is a vital document which the provider should refer to when preparing a claim. 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.

Deadline for claim submission – Usually, the medical claims have deadlines for submission, and you must note them. If you do not submit the claims at the right time, then the insurer can reject them. 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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