A National Medical Billing Company
Effective Claim Denial Management in Medical Billing
helping the medical industry grow
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Highlights of Our Claim Denial Management Service
01.
Identify past denial reasons such as; missing information, incorrect coding, coverage termination, and more.
02.
Categorize and assign denials and rejections reasons to respective teams for corrective action.
03.
Correct claims format and data requirements to meet the standards and avoid being rejected and denied.
04.
Track the status of the resubmitted claims with regular follow-ups.
05.
Submit appeals on your behalf for previous rejected claims.
Claim Denials
& Rejections
Management of claim denials and rejections is essential for a healthy cash flow and effective revenue cycle management. With so much rules that can lead for being denied or rejected, most medical practitioners will unable to avoid facing problems during the process. Here in MedCal, we can assist you in determining the cause of denials and rejections, reducing the risk of future denials, and getting paid faster.
Denied Claims
Denied claims are those that have been received and evaluated by the payer but have been determined to be unpayable. These claims could be in violation of the payer-patient contract, or they could simply contain a critical inaccuracy that was only discovered after processing. A claim that has been denied cannot simply be resubmitted. It’s important to figure out why the claim was denied.
The majority of denied claims are appealable and can be referred back to the payer for processing. Because this process can be time-consuming and costly, it’s critical to submit as many “clean” claims as possible the first time. If you resubmit a refused claim without filing an appeal or reconsideration request, it will almost certainly be considered a duplicate and denied, and the claim will go unfilled, costing your practice even more time and money.
Rejected Claims
A claim that has been rejected has one or more flaws that were discovered before it was processed. Because the data criteria were not completed, medical claims that were rejected were never entered into their computer systems. The insurance company will not pay the bill due to errors, and the rejected claim will be returned to the biller to be corrected. A clerical error or a mismatched procedure and ICD code might lead to a claim being rejected.
Rejections (when a claim is submitted electronically) are commonly reported as an EDI Rejection (electronic claim error) and do not appear on the insurance company’s Explanation of Benefits or Electronic Remittance Advice. A mere transposed digit from the patient’s insurance ID number can cause these mistakes. Since it was never entered into their system, a rejected claim can be resubmitted once the inaccuracies have been remedied.
Claim Denials
& Rejections
Management of claim denials and rejections is essential for a healthy cash flow and effective revenue cycle management. With so much rules that can lead for being denied or rejected, most medical practitioners will unable to avoid facing problems during the process. Here in MedCal, we can assist you in determining the cause of denials and rejections, reducing the risk of future denials, and getting paid faster.
Denied Claims
Denied claims are those that have been received and evaluated by the payer but have been determined to be unpayable. These claims could be in violation of the payer-patient contract, or they could simply contain a critical inaccuracy that was only discovered after processing. A claim that has been denied cannot simply be resubmitted. It’s important to figure out why the claim was denied.
The majority of denied claims are appealable and can be referred back to the payer for processing. Because this process can be time-consuming and costly, it’s critical to submit as many “clean” claims as possible the first time. If you resubmit a refused claim without filing an appeal or reconsideration request, it will almost certainly be considered a duplicate and denied, and the claim will go unfilled, costing your practice even more time and money.
Rejected Claims
A claim that has been rejected has one or more flaws that were discovered before it was processed. Because the data criteria were not completed, medical claims that were rejected were never entered into their computer systems. The insurance company will not pay the bill due to errors, and the rejected claim will be returned to the biller to be corrected. A clerical error or a mismatched procedure and ICD code might lead to a claim being rejected.
Rejections (when a claim is submitted electronically) are commonly reported as an EDI Rejection (electronic claim error) and do not appear on the insurance company’s Explanation of Benefits or Electronic Remittance Advice. A mere transposed digit from the patient’s insurance ID number can cause these mistakes. Since it was never entered into their system, a rejected claim can be resubmitted once the inaccuracies have been remedied.
Identify Opportunities with Proper Payment Posting
Errors, both human and computer, are unavoidable. Because medical billing involves both health and money, it’s critical to eliminate as many of these errors as possible. When an insurance company denies or rejects a claim, it can throw your revenue cycle into disarray. Our goal at MedCal is to make sure you are paid for the services you provide.
Run Your Billing
for Half the Cost
Are you looking to cut costs to your practice and bring more money in your door but you’re not sure how? Would you practice benefit from having $7,000 a month extra? If your answer is YES to either of these questions, then we are the company for you.