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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. Many people make mistakes and errors in submitting claims, and they do not know why the claims get rejected even if they try it severally and for that reason, it is essential that you get conversant with some of the factors which can lead to medical claim rejection by an insurance company. You have to realize that making a successful claim is not only your duty but your medical service provider also plays a crucial role. This article highlights some of the mistakes made during medical insurance claim and how you can go about them.

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. If any of the details lack on the claim form, the insurer will deny the claim. 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 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 is a duplicate claim and will not go through when the insurance company notices. The medical service provider should invest in qualified staff to prepare the claims to ensure that no duplicate.

Service already adjudicated – Sometimes, a claim can be made when that claim had already been settled in another payment. 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 – 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.

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. 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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