Rejection Hurts—  Follow These Tips When Addressing Electronic Claims To Ease The Pain

Rejection hurts. In eyecare, a rejected claim can delay revenue and cause unnecessary rework for you and billing staff (which can be the most painful). Here's a pro tip- before you can learn how to prevent a rejection, we need to understand what a rejection is and how it impacts your cash flow.

Today's blog discusses how billers can prevent rejected claims and what processes to follow to help minimize future rejections If you need help keeping up with these processes, consider outsourcing.

CLICK HERE to request a consultation and see if outsourcing to VisionWeb's Revenue Cycle Management team could help.

Help Ease The Pain When Addressing Electronic Claims

Before we learn how to rework a rejected claim and how to prevent future rejections, lets better understand what a rejected claim is and why it can hurt your cash flow. In optometry, an example of the most common reason a claim returned by insurance companies' requirements failed to meet the billing criteria needed to identify a patient. The insurance requires more data to determine the patient to pay for the exam or visit, causing revenue loss.

Identifying Rejection Reason

Now that we understand a rejected claim, we can identify why the insurance company returned the claim and begin the rework process. Some of the more common reasons for a claim rejection include the following:

  • Incorrect information
  • Invalid Code 
  • Duplicate Claim

Correct the Error To Resubmit

The next step to addressing the rejected claim is correcting the error for resubmission. If the error is due to incorrect or missing information, review the patient data in the patient profile and confirm the patient’s coverage information.

Prevent Future Rejections

Human error is inevitable. Having a process in place to rework rejected or denied claims is what will prevent loss revenue. However, if your practice is unable to keep up and starting to feel overwhelmed your practice should use a clearinghouse solution equipped with advanced claim scrubbing capabilities to help create a 98% first-pass rate. As long as you keep up with the claims and prioritize rejections, your biller can make your practice more money.


Are you overwhelmed trying to keep up with constant billing changes? If so, it may be time to consider outsourcing your billing needs. Click here to request a RCM consultation. 

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