Essay Question: Is their a way to help Allison not be overwhelmed and have over a 100 returned claims hidden in a drawer?

by Linda
(Springfield, Mo)

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.


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