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.

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