Denied Insurance Claims – Tip Series 1

Denied insurance claims seem to be one of the areas that many medical offices struggle with.  They either do not have the time to deal with them, or they don’t know what to do with them.  In any case, denied insurance claims can cause much loss of revenue.  If not handled and not handled properly, the provider can lose out on income that is due to him.  We are starting a series of tips on handling denied insurance claims.  Our first tip is on making sure that all claims affected by a denial are corrected and resubmitted.

Tip #1:  Make sure All Claims Affected are Corrected and Resubmitted:

One thing that tends to get overlooked when handling denials is to check for other outstanding claims on a patient when a denial is received that will affect all claims out on a patient.  For example, if a denial is received for a patient because the patient’s insurance has changed then all claims submitted for that patient after the change of insurance will need to be corrected.

Many times a biller will receive a denial for one particular date of service, make the correction and resubmit just that one claim.  They don’t take the time to look and see if there are any other claims out for the patient that also need correcting.  As I’m writing this I’m thinking it would be a no brainer, but in all of my years of training this is actually something that needs to be taught especially with new or inexperienced billers.  They just don’t think about the whole picture without being taught to.

It is not uncommon for us to be checking over the work of a newer or inexperienced employee to find that they were informed of an insurance change on a patient.  The information that they received was for one specific date of service.  They corrected that one claim and resubmitted.  What they didn’t do was to look at the patient’s file to notice that there were several other dates of service out there also submitted with the incorrect insurance information.  Those claims also need to be corrected and resubmitted.

We also teach them to look at the other family members as well.  If the insurance changed for one of the children and the policy is through the parent, it most likely changed for everybody in the family.  Looking into it now can save much work later on and even prevent money from being lost.

If the denial is for something that is only specifically related to the claim in question then this is not an issue.  But if the denial is for something that would affect all claims for the patient and/or family, then it is important that the biller take the time to make sure all claims are corrected and resubmitted and not just the one that received the denial.

Issues that may affect multiple claims for a patient:

•    Change of insurance carrier
•    Change of insurance ID number (Blue Cross Blue Shield often changes ID numbers!)
•    Truncated or invalid ICD code (this can affect multiple claims for specialties such as mental health, PT, chiropractic and others)
•    Invalid patient information such as date of birth or misspelled name

For more information on Handling Denials see our online course:  “Reading EOBs, Handling Denials and Filing Appeals”

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