When an insurance claim is denied, it can be really difficult to appeal. Once a claim is marked as unpayable, an appeal needs to discuss why it was marked as such as well as prove why the medical claim should be approved. Prepare yourself with these most common reasons for medical claim denials and reach out to CHRM to discuss further if you’re looking for medical billing companies to provide solutions to your problems.
Duplicate Medical Claims
Healthcare Finance News reported that one of the most common reasons for medical billing denials was duplicate submissions. Duplicate claims are often at the fault of the provider, which can be a frustrating experience for all involved. Establishing a cohesive workflow can prevent this from happening.
Technicalities in Medical Insurance Billing
Manual errors in paperwork can be so easy to overlook but can cause a medical claim to be denied. Missing information or typos are so common and can easily be avoided by better administrative processes.
Insufficient Coverage in Medical Claims
Deductibles, network providers, and benefit eligibility are all things to be aware of when reviewing medical coverage policies. It’s important to look at what is covered and what isn’t, as this is often a common reason for rejected medical claims.
Inappropriate Medical Insurance Billing Claims
Similar to insufficient coverage, medical insurance claims need to be for a valid medical procedure or service that can be covered. Some services are deemed not medically necessary so can be denied without investigation. It’s important to prove why a medical procedure is required and why it should be covered.
Insurance claim denials can be common if you don’t know what to look for or how to avoid them. These most common reasons can often be avoided with a good medical billing company to assist with all your needs. Contact CHRM to find out how we can be beneficial for your business.