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Claims Processing: Could My Claims Be Returned by the Insurance Company? Why?

Health Insurance Denied Form Showing Unsuccessful Medical Application

Claims can be returned for a variety of reasons. The most common cause for a rejected claim is missing or inaccurate information. For example, errors in patient data such as the date of birth, age, sex, address, or name will cause an immediate return. Then there is provider information and insurance identification numbers, which can be easily and unintentionally misrepresented.

When the insurance company payer receives a claim, they check to make certain the patient is covered by the policy and all treatment codes match the appropriate diagnosis. Sometimes preauthorization records, referring physician identification numbers, or evidence of medical necessity is left incomplete.

The use of a medical claims processing software ensures all required information is included in the claim, prior to submission to the insurance payer. The software will catch any obvious errors such as missing or invalid information easily. The best way to increase claim payments is through prevention, submitting a clean claim the first time without any errors.

A medical billing software solution is well worth your investment. Apex EDI wants to simplify claims processing for you, so you can get paid faster. Contact Apex EDI to watch a free demonstration of our software today.

Posted in: Claims Processing

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