Are you aware of Common Claim Denial Reasons?

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• Are you aware of Common Claim Denial
  Reasons?

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Are you aware of Common Claim Denial Reasons?
Understanding the reasons why medical claims get
denied by insurers can help limit the number of
denials your medical office reimbursements. The
only way to prevent them is to be aware of what
they are. You might be aware of common claim
denial reasons. Here are some common reason why
medical billing claims get rejected. Delay to
file claim Most insurance companies allow 60 to
90 days from the time of service to file a claim.
When claims are filed too long after the date of
service, they are rejected. If the bill was
submitted to EDS before it was submitted to the
patients private insurance company. Get all
insurance information from the patient even if
that insurance will not pay for services
provided. Submit the claim to the Primary carrier
then send in a bill with the attached Explanation
of Benefits (EOB) to EDS. Missing Correct
Codes Diagnostic code (ICD-10 code) and CPT code
are missing, incomplete, invalid, or do not
correspond to the treatment rendered by the
physician. The Insurance Company Misplaced the
Claim, and then the Claim Expired
Medical Billing Services in Oregon
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Are you aware of Common Claim Denial Reasons?
Irrespective of how it was misplaced, if a
misplaced claim doesnt enter it into the
insurance companys system before the deadline,
the claim will be denied. Pre-authorization Pre-
authorization is an essential for many insurance
plans. Providing services without the proper
authorization will cause the claim to be
rejected. Two Services in One Day If a patient
is authorized for 12 sessions of therapy and if
you provide two sessions in one day then you
wont get paid for the second session. Physicians
who have group therapy, psychological testing, or
medication reviews beware sometimes these
services also come under the one service per day
policy. The Provider is not credentialed with
the Insurance Company If a physician attend a
patient and he isnt a credentialed with the
patients insurance company, the claim will be
denied? If a physician was working for a larger
clinic, he (or she) might think that he is a
panelled provider, when really he was working
under his old employers contract with the
insurance company.
Medical Billing Services in Oregon
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Are you aware of Common Claim Denial Reasons?
Wrong Location When a counsellor is panelled with
an insurance company, they list one (or multiple)
practice addresses. It is important to make sure
that providers have all the places they serve
patients registered with all the insurance
companies they work with. Provide services at an
unregistered location, and the claim could be
denied. To reduce your claims rejections and
improve reimbursement call us today at
302-261-9187 or email us at info_at_medisysdata.com
to know more about how to avoid such issues to
process the payment faster.
Medical Billing Services in Oregon