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.
Mar 31, 18 09:47 AM
Besides networking .. visiting their offices, how else can you attract their business? When you close the collections month, how do you bill the physicians?
Mar 31, 18 09:36 AM
I have a potential client that is requested claim scrubbing resolutions (only corrections on claims submission errors) and insurance verification on the
Mar 31, 18 09:28 AM
The provider that I bill for just advised that he has a new tax ID. What is the process for this change? Would every insurance company need to be contacted?
Disclaimer and Privacy
Copyright 2018 All-Things-Medical-Billing.com