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.
Here’s more in-depth discussion on healthcare claim processing errors.