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Common Errors of Medical Claims and Proposed Remedies

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 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. Most people tend to forget filling in the details, and that leads to medical claim denial. You can avoid this mistake by double checking the claim form to ensure that every field is duly filled.

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 kind of claim submission is not allowable, and the insurance company will reject it. The medical service provider should invest in qualified staff to prepare the claims to ensure that no duplicate.

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. There is the latest software for processing medical claims, and if you choose the best one, you will not have this problem.

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. 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.

Filing date expired – You should note that medical claims have deadlines for submission and you must adhere to them. If you submit the claims late, the insurer will automatically reject it. 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.

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