Essay Question: Is their a way to help Allison not be overwhelmed and have over a 100 returned claims hidden in a drawer?
Allison is overwhelmed in her new job in the insurance claim processing department.
Her supervisor is looking for a pending claim in Allison's desk and finds a drawer marked "Returns" which contains nearly a hundred returned claims sent back by the carriers for various reasons. List 3 reasons that claims could be returned by the insurance companies.
This is my question: Is their a way to help Allison not be overwhelmed and not have over a 100 return claims hidden in a drawer:Response:
There are many reasons for a claim to be denied or rejected. Some of the most common causes I've seen are:
- Errors to patient demographic data - age, date of birth, sex, etc. or address.
- Provider data errors.
- Incorrect patient insurance ID.
- Patient no longer covered by policy.
- Incorrect, omitted, or invalid ICD or CPT codes.
- Treatment code does not match diagnosis code.
- Incorrect or missing modifiers.
- Requires pre-authorization.
- Incorrect place of service code.
- Lack of medical necessity.
- No referring provider ID or NPI number.
Here's more in-depth discussion on healthcare claim processing errors
Click here to post comments
Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.
Jul 12, 17 08:25 AM
I have been a dental hygienist for 6 years and I am ready to start my own business. I have decided I do not want to drift far from the world of dentistry
Jul 12, 17 08:24 AM
I have a background that is not a good background. My question: Are background checks done? If so, what are they looking for? Is it up to the hiring
Jul 12, 17 08:19 AM
In gulf countries they can't understand what medical billing is, where lots of billing jobs available but I need what exact role name of it to apply job
Disclaimer and Privacy
Copyright 2017 All-Things-Medical-Billing.com