Below are some of the haunting reasons for denied claims.
The Most Haunting Reasons Your Electronic Claims were Denied
Your Biller Submitted a Duplicate Claim
The most common reason for a payer to deny your electronic claim is that your biller submitted multiple claims with repeated information. This typically happens when the billing manager finds an unpaid claim and resubmits it without identifying the original claim submission. To avoid this reason for a denied claim, use the resubmission feature within your electronic clearinghouse solution instead of submitting an entirely new claim.
Your Patient’s Insurance Wasn’t Really There
Typically, when a claim is denied due to a patient being identified as uninsured, it’s due to a data entry error. To solve this mystery, you can pull the patient’s benefits prior to the exam and double check the information.
You Filed Your Claim Too Late
Missing your window to file a claim is the most horrifying reason that a payer denied your electronic claim. While there are a number of reasons why your billing manager missed the claims submittal deadline, it usually comes down to the fact that there were just too many claims that needed to be worked. Help your optometric biller out by prioritizing what claims need to be worked based on the timely filing guidelines.
If you're letting VisionWeb's expert team handle your billing, you don't have to worry about denials. Read a success story below.