The last thing anyone wants to worry about when in need of medical care is whether their health insurance will cover the issue. Unfortunately, there are many reasons a medical claim may get denied. Fortunately, there are ways of potentially getting a denied claim reversed. Here are some tips to keep in mind the next time you are dealing with an insurance claim being denied.
Identify the Reason for the Denial
Before you can properly address denied claims, you must know what caused them to be denied in the first place. Whenever a claim is denied or approved, you should receive an explanation of benefits (EOB). The EOB uses codes to help explain the reason the claim was either denied or approved. There will often be a key for these codes, which makes it easier to understand what they mean. If you’re still uncertain as to why a claim was denied, you can always ask the company for clarity.
Gather Up Evidence
You may need to be able to provide evidence showing that the services you needed were medically necessary. Having medical history on-hand, including referrals and prescriptions, can give a claim a better chance of getting approved.
Start With Simple Problems
Sometimes, a claim can get denied because of something simple, such as a misspelling of the patient’s name, having the wrong date of service, or having the wrong insurance ID number. Make sure there aren’t any errors in your documents before you send them. If you find an error, make sure it gets addressed before the claim is resubmitted.
Get Together With Your Team
It’s much easier to handle denied claims when you have a team working with you. All departments need to come together to unravel the root causes of why a claim is denied. At first, other departments might be apprehensive about this idea because no one wants to feel like they’re being blamed for a denial. However, being open with your team will serve you well in the long run.
Try to Detect Trends in your Data
In the world of denial management, data is critical. Often, you’ll be able to find trends in your data through Analytics. Analytics can be used to help you find the patterns in your data, good or bad. You should make sure you’re using Analytics to find trends that could be costing you revenue.
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