One of the most common reasons for claim denials given by payers is that a patient lacks insurance coverage or has had their coverage terminated.
When receiving this particular claim denial, all options need to be exhausted by the provider to determine if a clean claim can be resubmitted, so payment can be collected. Luckily, there are a couple of paths you can take to quickly reveal whether the claim is ready for a successful appeal.
Check for Payer Errors
Just as medical billers aren’t perfect, neither are payers. This holds true for large payers such as Blue Cross and Blue Shield as with smaller payers as well.
If possible, search through the payer’s website to locate a patient’s file and find out if their insurance ID number has changed. If that’s the case, the provider portal should give you the patient’s correct ID number, so you can resubmit a more accurate claim.
Also, check the patient’s claim history. If the payer has made payments for that patient before and after your date of the service, reach out to the payer to question the claim denial.
Contact the Patient
In the event, the denial appears to be correct or you can’t easily locate the necessary information, it is time to get in touch with the patient.
One non-intrusive method is to mail a statement of charges to the patient, stating that their insurance was denied due to a lack of coverage. Once a bill is received, the patient is likely to contact your practice and their insurance company to inquire about the charges.
Of course, you can always reach out to them directly by phone or email. This can be more cost and time-efficient than sending out bills, which will likely be disputed.
In certain cases, the patient recently changed their insurance provider and forgot to notify your practice. Once the updated information is obtained, the claim can be resubmitted to the correct payer.
It’s worth noting that much of the fuss over this common claim denial can be bypassed with a quality PM system that checks patient eligibility prior to claim submittal. Even when the aforementioned quick fixes are successful, nothing beats submitting a perfect claim the first time.
If you’d like to find out how our web-based PM system can help you avoid claim denials, please contact us at 1-877-342-7517 or hello@carecloud.com.
