Avoid Claims Processing Denials and File Claims Correctly The First Time

Posted by Janelle Pauli on Thu, Jun 30, 2016 @ 14:06 PM

Claim filing can be one of the trickiest tasks in your eyecare practice. There is so much to keep up with, and things are constantly changing. All of that put together makes claim denials a common and recurring theme in many practices. On the bright side there are several common reasons for denials that many practices share, and we're here to help you overcome those most common denials

Get Your Claims Processing Cycle on Track by Filing Claims Right The First Time

If you're able to tackle your most common denials, you'll be well on your way
to filing your claims correctly the claims processingfirst time instead of having to resubmit claims later. If you're using a clearinghouse or practice management solution for claims processing, denial reasons should be easily found on your ERA. If you're not posting and reconciling payments through your system regularly, you won't see an accurate number of denials in your system, and keeping up with payments will be even more challenging. 

As we mentioned before, there are common claim denial reasons that many eyecare practices deal with. Let's take a look at the top reasons:

1. Duplicate Claims - Two or more submitted claims that include repeated information about patient demographics, provider, date of service, and billing codes.

2. Payer Doesn't Cover Service - The service you provided isn't fully covered by the insurance plan your patient has.  

3. Late Filing - Submissions filed after the claim submission deadline as outlined per payer.

4. Bundled Payment - Payments bundled into another procedure can cause payments to be made to another service provider. 

5. Uninsured Patient - Patient can't be identified as insured.

6. Coverage Termination - Coverage termination due to late or non-payment on insurance premiums paid monthly. 

7. Payer Doesn't Support Frequency of Services - Claims can be denied if the service wasn't deemed a "medical necessity" by the payer. 

If you're being hit with these common denials we have a resource that will walk you through the steps to take when these denials happen, and how you can avoid them in the future. Get your billing cycle back on track with help from our Claim Filing Denials Guide

Get Your Guide to Common Claim Filing Denials

Tags: Practice Efficiency, Resources, Electronic Claim Filing