Reasons for Medical Claim Rejection and How to Avoid Them
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. Suppose any bit of information is missing from the claim form, then there are high rejection chances. 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 is a duplicate claim and will not go through when the insurance company notices. Having a competent team of employees and installing medical billing software can significantly reduce the double claim instances.
Service already settled – In some cases, an insurer can settle a claim for a different payment, and that can lead to rejection of the current claim. Through embracing the latest technology on claim processing, you can avoid the instances of service already adjudicated. You can install claim processing software in your organization but ensure you choose the best one which matches the requirement of the insurance company.
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. It is essential that the medical facility gets it right about patients’ benefit plan before claiming because anything outside that will be rejected. It is recommendable to refer to a patient’s benefit plan when preparing a claim or before you offer the services.
Deadline for claim submission – Usually, the medical claims have deadlines for submission, and you must note them. If you submit the claims late, the insurer will automatically reject it. However, it is crucial that you submit the claims in time so that even if it is rejected, you have ample time to make corrections and file the claims again before the deadline is due.