When Uninsured Patients Cause an Electronic Claims Denial

When the patient can’t be identified as insured by your eligibility check, it can cause a claim denial later on whenever you try to submit a claim for services you provided them. It’s important to check for eligibility to ensure that your patient is covered and if they aren’t, you should try to determine the cause of the problem sooner than later.

An uninsured patient doesn’t necessarily mean that they do not have insurance coverage; it can be due to incorrect coverage information or a data entry error...

How to Prevent Electronic Claim Denials with Uninsured Patients

Uninsured patient_electronic claimsIncorrect coverage source information usually happens when the patient did not provide complete information to the insurance company when they were setting up their plan. Data entry errors, on the other hand, refer to a staff member in your practice entering the wrong policy number or wrong demographic information. Let’s go through how to fix both errors.

Incorrect Coverage Information

Incorrect coverage source information is the patient’s responsibility. There’s not much you can do here, but to explain to the patient that they aren’t actually insured and need to get in contact with their insurance plan to fix the problem. You can then make the decision on whether to write off the bill yourself, or bill the customer.

Data Entry Errors

Correcting data entry errors, on the other hand, is your responsibility, but it is a problem that’s easy to avoid. When the patient comes in for their appointment, make sure you double check for the following items:

  • Name
  • Date of Birth
  • Responsible Party
  • Vision Insurance – policy and policy numbers
  • Medical Insurance – policy and policy numbers

On top of checking for this basic information, there are also a couple of entities to be aware of like sister insurance companies and Medicare Advantage Care.

  • Sister companies: Big insurance companies often acquire smaller insurance companies. When this happens, it provides patients with a wider network of providers, and new insurance cards may be handed out to patients.

However, insurance companies usually retain their independent, existing contract prior to the acquisition with providers like you. Therefore, in most cases, you should be filing your claims to the individual payers. Every contract is different, but you should be aware of the main insurance company to file your claim to, instead of just looking at the logo on the patient’s insurance cards.

  • Medicare Advantage Care: Similar to the sister companies, just because a patient has a Medicare card, it doesn’t mean that you should file the claims to Medicare. A lot of times, Medicare claims are processed by other insurance companies. It’s important to know which one to file to.

Uninsured patients are only one of many reasons that your claims can get denied. Download our eBook to find out the top 7 reasons for why your claims get denied and find out how to prevent and fix them!

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Originally published in November 2015. Updated in May 2022.

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