Every biller in the healthcare industry knows how frustrating it is to receive a denied insurance claim. Even practices using high-powered billing software have to deal with denials now and then. Since we all know we’ll see the dreaded denied message again, it’s important to understand the best way to handle them. Following a logical, productive process to understand, fix, and resubmit your denied claims will put the power in the hands of the biller and take the fear out of denied claims.
Understand the Reason for the Denial
To solve a problem, you have to first understand it. When you receive a denied claim, the payer should have included an explanation as to why they couldn’t accept the claim as is. Once you understand the explanation, you’ll know whether it was a mistake in your data entry or a mistake on the payer’s end. Often, denials come from incorrect code and data submission or expired patient insurance coverage. If you understand the error, you can fix and resubmit right away. If you find your company receiving a handful of denials, it’s important to tweak your process in the future to prevent denied claims.
Appeal Your Denied Claim
If you believe your claim was denied in error, you have the option to appeal it. The best way to ensure your appeal is accepted is by providing as much paperwork evidence as possible to prove your claim was actually submitted correctly the first time. You should also check the payer’s appeal process and make sure you use the correct format and provide any required paperwork. If you truly believe the claim shouldn’t have been denied, don’t give up. It might take a couple appeals and phone calls, but eventually the problem can be fixed.
Resubmit in a Timely Manner
Every payer will offer a different time frame to file appeals. Knowing how much time you have to resubmit your claim will keep you in line. This isn’t the time to procrastinate, because even if the time frame is generous, there’s a chance you could be denied again and have to resubmit once more. Give yourself as much time as possible.
Understand the Appeals Process
Processes differ from payer to payer. This is why it’s a good idea to regularly check their websites for updated policies and file away any documents received for reference when this time comes. This way, you don’t have to waste time searching for information and can get straight to appealing your claim.
Keep Records of Your Claims and Disputes
As you should with almost everything in healthcare, keeping records of your disputed claims, why they were disputed, and the outcome, is a good idea. Recordkeeping is useful for a number of reasons, but it’s especially helpful when the time comes to appeal your claims. You’ll thank yourself for being organized when you need to act fast.
Reduce Claim Errors With Medical Billing Software
There’s no guaranteed way to eliminate billing errors for good, but working with a reliable medical billing software is a great way to reduce the number of rejected and denied claims your company sees. If you’re looking for a solution to your billing troubles, check out a free demo of Claimgenix. Our team is happy to work with you and discuss what will work best for your business, so give us a shout soon to schedule your demo!