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Common Errors of Medical Claims and Proposed Remedies

A lot of people are grappling with rejected medical claims, and they are still frustrated because they do not know how to go about the process. Unfortunately, this problem is common in the recent times, and perhaps, it is high time that you know some of the mistakes made by people during medical claims and how you can avoid such mistakes to make a successful claim. Submitting a successful claim is a collective effort that requires the participation of a team of competent employees in the organization. This article highlights some of the mistakes made during medical insurance claim and how you can go about them.

Missing information – Before an insurance company accepts a claim, it goes through the details submitted to it. Vital information on the claim form might include demographic details, plan code and social security number. Most people tend to forget filling in the details, and that leads to medical claim denial. You can avoid this mistake by double checking the claim form to ensure that every field is duly filled.

Double claim – If two claims are made to the insurance company on the same day for the same kind of service offered by the medical facility, then the insurance company will deny the claim. This kind of claim submission is not allowable, and the insurance company will reject it. The medical service provider should invest in qualified staff to prepare the claims to ensure that no duplicate.

Service already settled – In some cases, an insurer can settle a claim for a different payment, and that can lead to rejection of the current claim. If you have the right medical billing systems in your organization, then you can avoid claim rejections of this nature. If you to minimize such instances in your organization, you can install the latest medical billing software which assures accurate processing of claims.

Not covered by payer – A high percentage of claim denials are due to procedures not covered by payers. If the provider makes a mistake of claiming the service that is not in a patient’s benefit plan, then the insurer will turn it down. The best remedy for this problem is to confirm the insurance eligibility response or even calling the insurer before you give the services.

The limit for filing expired – It is essential to submit the medical claims in time before the filing date expires. If you do not submit the claims at the right time, then the insurer can reject them. However, it is crucial that you submit the claims in time so that even if it is rejected, you have ample time to make corrections and file the claims again before the deadline is due.

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