Do you know about - 10 base Reasons Why curative Claims were being Denied and your performance Plan
Health Plans! Again, for I know. Ready to share new things that are useful. You and your friends.(1) Incorrect patient's information (insurance Id# , date of birth) If you are submitting electronic claims, Avoid entering patient's insurance estimate with characters like an asterisk (*) and dash (-) in in the middle of the alphanumeric numbers because these characters can be recognize by electronic as unrecognizable. Just check on this issue with the clearinghouse or your service provider. always make a copy of your patient's traditional & secondary insurance card on file (copy front and back!). Make sure to get a copy of their new card (if there is a change).
What I said. It isn't outcome that the true about Health Plans. You read this article for information about a person wish to know is Health Plans.How is 10 base Reasons Why curative Claims were being Denied and your performance Plan
We had a good read. For the benefit of yourself. Be sure to read to the end. I want you to get good knowledge from Health Plans.(2) Patient's non-coverage or terminated coverage at the time of service may also be the infer of denial That is why, it is very prominent that you check on your patient's benefits and eligibility before see the sick person (unfortunately, I have seen practices who does not check on benefits and eligibility on their patients so they end being not paid for the service they rendered to the patient)
(3) Cpt/Icd9 Coding Issues (requires 5th digit, outdated codes)--- be careful
also with your secondary code! Claims may be denied even if the qoute was just because of the secondary Cpt/Icd9 code! Again as I previously pointed out with my other articles on tracking your claims, with this problem, discuss solving the coding error rather than how much you want to get reimbursed. Most of the insurance companies will help you with codes (in fairness!!) and they also edify you on outdated codes, or codes that requires a 5th digit. Be nice with the claims department! (at least you try!)
(4) Incorrect use of modifiers! (be true with bilateral procedures!, modifiers for pro and technical component, modifiers for many procedures, postoperative period, etc.)
(5) No precertification or preauthorization obtained (if required) It is so hard to file an request for retrial when the claim or service was non-precertified. Avoid it from happening!
(6) No referral on file (if required) Note: Hmos always requires a referral! (remember that!)
(7) The sick person has other traditional insurance or the patient's claim is for workman's comp or auto accident claim! It is the responsibility of your front desk staff to get all the principal information before the sick person can be seen. Remember that if this is a workman's comp or an auto accident claim, you need a claim estimate and the adjustor's name. Services are always preauthorized!
(8) Claim requires documentation & notes to retain healing necessity A well documented healing records is a good practice!
(9) Claim requires referring physician's info (with Upin ofcourse!-this will be soon replaced by an Npi or the National victualer Identification number)
(10) Untimely filing Unfortunately most of the insurances does not accept your billing records on your office computer that shows that date(s) you billed the insurance! They want a receipt from your electronic receipt or for postal mail, obviously they want a receipt too! a tracking estimate maybe? certified letter receipt? If you are submitting claims by electronic, make sure you generate transmission reports/receipts. Your reports must read "accepted" and not "rejected". File all these transmittal reports/ and receipts and a very safe place! If you are sending claims by paper or postal mail, it is a good idea to send your claims as certified mail with tracking number, keep your receipts!!
