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Claims Processing: 5 Things You Must Know About Denied or Rejected Claims

Denied and rejected medical claims result in substantial financial losses for medical, dental, and vision practices. This is why it’s important to stay vigilant about these denied and rejected claims and keep on top of resolving them. Here are a few things that you should know about these claims that will help your office better deal with them.

1. The Difference Between Denied and Rejected Claims

Denied and rejected claims are not the same. A denied claim is one that is determined unpayable by the insurance company. Sometimes these are due to error on the part of those submitting the form and sometimes it is due to patient ineligibility for services rendered. Either way, the insurance company will let the office know what the reason for denial was on the Explanation of Benefits (EOB).

These claims can be appealed, but it’s better to try and avoid these if possible. A rejected claim is sent back due to errors, and is simply resubmitted with corrected information. Because constantly appealing and re-submitting denials and rejections can be costly and time consuming, it’s worth investing time and resources into ensuring claims are filed successfully the first time.

2. The Most Common Reasons for Denials and Rejections

Insurance companies have very strict requirements when it comes to how claims should be filed. Some of the most common reasons for rejections include incorrect service or diagnosis codes, missing or incorrect patient information, and insurance specific requirements that aren’t met. Hiring a reliable clearinghouse, like Apex EDI, that can scrub for errors and keep track of insurance specific requirements will help you avoid these errors, and save you time and money in the long run.

3. How to Resolve Issues Quickly

Many claim errors are made because of imperfect or out-of-date information somewhere along the line between scheduling an appointment and submitting the claim. Small oversights such as failing to consistently ask patients about changes to their insurance or patient information during sign in, or failing to keep up to date with insurance-specific requirements can lead to many unnecessary denials and rejections. Communication is key to ensuring that the most correct information is always used on claims.

4. Trends in Your Denied and Rejected Claims

Keeping track of trends in denied and rejected claims can help you catch repeating issues. By digging a little deeper you may find that a specific code or repeated error may be to blame for a large number of denied or rejected claims, and you may be able to significantly reduce the time and money you spend on resubmitting by simply resolving the error for future claims.

5. How Apex EDI Can Save You Time and Money

Using a reliable, hard working clearinghouse can help you reduce administrative costs, reduce the number of denied and rejected medical claims you have to deal with, and save you the time and money that is often lost through mismanaged claims. We have a feature rich program that makes it easier than ever for you to file your claims and catch mistakes the first time. Click here to discover all the features we offer and to learn more about how we can help you get paid faster with fewer headaches.

Posted in: Claims Processing

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