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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Many claim errors are made because of imperfect or out-of-date information somewhere along the line between scheduling an appointment and submitting the claim.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: Apex EDI, EDI, Medical Claims, Uncategorized

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How Are Medical Claims Processed?

File Folder Labeled as Claims in Multicolor Archive. Closeup View. Blurred Image. 3D Render.

Once medical services have been administered to a patient, payment needs to be requested from insurance through appropriate channels. These requests for payment are known as medical claims, and to the lay person, filing them may seem rather complicated. We’re hoping to demystify this process by breaking down the way medical claims are filed and paid.

Each service rendered to a patient has a designated code so that the payer will be able to reference them against codes and services the patient is eligible for. These codes along with insurance and patient information make up the bill that is sent on to a clearinghouse on its way to the patient’s insurance provider. Medical bills are often processed and submitted through online channels because it saves time and money, but hard copies are still available and occasionally used for this process.

This is where Apex EDI comes in. Forms are sent through clearinghouses like Apex EDI before being sent on to the insurance company so they can be scanned for errors and reformatted to comply with HIPAA and insurance company standards. Clearinghouses like ours are necessary because each insurance company has different standards, and doctors offices are responsible for submitting high volumes of claims to different insurers on a daily basis. Without a clearinghouse, the strain on the billing department of the office would be astronomical.

The doctor’s office chooses which clearinghouse it works with, and it’s important to select one that works with the insurance companies you work with, can work with the software you have available, and is reliable. Luckily, we at Apex EDI work with many different insurers as well as many different software programs. Visit our website or give us a quick call to see how we go above and beyond to serve all of your medical, dental, and vision claims needs. Choose Apex EDI to help you get your claims filed faster, get paid faster, and take the stress out of the claims filing process!

Posted in: Apex EDI, Medical Claims

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A Typical Visit: What your Physical Therapy Claim will Pay For

Physical therapists work with patients to increase strength, flexibility and movement following an illness or injury that results in a change in your physical movement. Seeing a therapist can help you get back to the daily activities you enjoy with a comprehensive recovery treatment plan. You will start with an evaluation to assess your injury and change in physical function.

During the first visit, you can expect to be asked about the history of your illness or injury and a number of questions about your symptoms. The therapist will perform tests to evaluate your range of motion, strength, flexibility, posture and mobility. The therapist will also explain your condition and the rehabilitative treatment plan designed for you.


Therapists are skilled at treating pain and discovering the underlying cause for it. Addressing the muscular issue causing the aches and throbbing you experience is critical to restoring pain-free movement. You will work closely with the therapist to describe the intensity, frequency and duration of any pain you experience.  

A treatment plan may include a combination of therapeutic exercise, “hands on” massage, stimulation of the body with heat or cooling and education about physical activity. Many therapists rely on the patient to perform at home exercises before and after treatments to ensure you regain movement quickly. The actions you take at home will help you recover quickly.


Most physical therapists can also offer advice for preventing future injury. This may include the design of living and work spaces to prevent pain from repetitive movements and preventative exercise routines.  Most forms of physical therapy treatment are covered by insurance.

Apex EDI helps get your physical therapy insurance claim paid quickly so you can return to the physical activities you enjoy.    

Contact us today to learn more.  

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Physical Therapy Claims, Wellness Claims

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A Typical Visit: What your Chiropractic Claim Will Pay For

A chiropractor can work with you to establish goals for reducing back pain and restoring the independence you need to participate in your daily activities. At the initial consultation visit, the chiropractor will complete a thorough 45 minute exam and diagnose a treatment plan. Most will also offer advice on how to avoid future back pain or injury.

Because this practice has a variety of techniques and approaches, it is beneficial to prepare ahead of time and bring a list of questions with you. You’ll also want to bring information about your medical history and background on the current injury. The chiropractor will ask you to describe the injury and pain in detail.

Your claim will pay for an exam that includes general tests to measure blood pressure, pulse, respiration, reflexes, muscle tone, muscle strength, and neurological integrity. Depending on your specific needs, you may also be asked to perform range of motion tests which require you to move in a specific manner, posture tests, or a spinal adjustment. There are hundreds of adjustment techniques used by chiropractors throughout the world to restore joint functionality, movement, and reduce pain.

By the end of your visit, you will discuss an ongoing treatment plan that may include future spinal adjustments, ultrasound, strengthening exercises, massage and education on proper posture or nutrition. For most types of lower back pain, 1 to 3 chiropractic visits per week for 2 to 4 weeks will be prescribed, followed by a re-examination. If needed, you may be referred to other specialists until your mobility improves and the pain ceases.

It’s easy to get started by researching providers in your area. You may want to ask for recommendations and discuss chiropractic approaches over the phone with the clinic to help with your selection. Once you’ve made your choice, Apex EDI makes it easy to get your chiropractic claims paid.

Contact us to learn more.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Chiropractor Claim, Medical Claims

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Who is Apex EDI?


We are Apex EDI and we are the best choice for electronic medical, dental and vision claims processing. We are committed to the fastest, most personal service and highest quality support in the healthcare industry. We are unique because our flexible technology offers the most complete range of features and works with any practice management software.

We at Apex EDI created the OneTouch® solution to offer you an easier and less expensive way to process your insurance claims electronically and receive faster reimbursement. Electronic claims are submitted in a simple two minute operation. Electronic patient statements and eligibility verification are also available.

Serving medical and dental providers in every state is what Apex EDI does. Our technology interacts with more healthcare payer organizations than any other EDI solution. Our growing international customer base has access to our website 24 hours a day and 7 days a week to manage and send their medical insurance claims to thousands of insurance payers.

Also, Apex EDI is one of Utah’s 100 fastest growing firms since 1995. We thrive because we offer unrivaled superior customer service. You simply won’t find our personalized approach to customer service anywhere else. You will always have a representative assigned to your account to speak to directly when you have a question or need help.

Our team of bright, creative problem-solvers are trained and experienced in every aspect of revenue management. We are ready to simplify the payment process for you so your team can focus on the wellness of your patients.

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Contact us to learn more today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Apex EDI

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