Some Common Mistakes That Cause to Claim Denials
A claim is a request placed to the insurance company to make payment based on the terms of insurance policy. The insurance company review the claims and then after a full round of reviews they approve the claims to the requester. The Insurance Claim Processing is an incommodious task and at times the work is so routine that many errors go unattended. It is important to make sure the errors are rectified timely and the reports and data updated to ensure the claims are cleared.
At times the claims get rejected for some unpredicted reasons, hence it is important to consider the mistakes and help the customer get the insurance claimed at the earliest. Here are few common mistakes that lead to claim denials:
- Un-enrolled patient: Sometimes the insurance is claimed for the patient who is not even enrolled for the insurance claim. This automatically results in a denial.
- Uncovered operation: At times, the medical procedure is not covered under the insurance, hence the claim gets rejected.
- The absence of pre-certification: Precertification is important for any insurance claim, as they contain details of the treatment as well as details of getting approval for insurance claimed regarding the treatment.
- Lack of procedure facility is also a reason for a failure of the claim.
- Inadequate referral or absence: Referral is important for any claim, at times the reference is absent and hence the claim is rejected. A valid contact is required as the reference or else the claim is denied or delayed.
- Numerical errors: Typing errors are commonly seen in any date entry works. Hence it is important to make sure such demographic errors don’t happen.
- Insufficient documents: The claim should contain necessary documents to support the medical claim, else it looks invalid and the claim is denied. The supporting documents can be regarding the medical history of the patient and other details which help to put forward the claim to the claim processing services.
- Illegible claims: Though this is the era of digitization, at times the manual filling of the forms are required, and with an unclear handwriting the forms are filled wrongly by the individual. This leads to erroneous reports to be filled even on the computer and hence there would be a great mismatch in the documents filled and the data saved.
- Missing information: The claim documentation requires the individuals to fill in every detail necessary and important, hence all the mandatory fields are to be filled and never left empty.
- Late claims: Most of the times, the only reason for denied claims are the late submission. Make sure the claims are submitted rightfully on time.
Denial of claims and getting reimbursements is a waste of time and money. Ensuring the claims are legally correct and submitted timely will be the best way to ensure the claims are not denied. Most of the insurance claim outsourcing also helps to ensure that the documents are apt and rightfully entered in order to ensure that the medical procedures work smoothly.