The claims process can be complex and lengthy. The complicated process makes for a challenge for even the most seasoned financial departments. Even the most diligent and experienced finance professionals experience claim denials, let alone everyday individuals filing a claim for the very first time. Having an insurance claim denied can lead to a major headache and sleepless night, in addition to a negative financial impact.
In a best-case scenario, after the initial claim is denied, the claimant can refile, and their claims are recovered. However, even in this situation, the costs that are associated with the initially denied filing must be subtracted. Aside from the mental drain and financial tolls, mistakes that lead to a claim denial may potentially fall under the broader categories of fraud and abuse. Although fraud generally does not take place unless the claimant takes conscious action to generate more profit. Nevertheless, mistakes during the claims filing process can lead to unnecessary mental health, financial, and legal troubles.
These are the three most common mistakes on a claim that will cause denials and how to avoid them.
1. Missing Or Incorrect Information Can Lead To A Claim Denial
One of the most common mistakes on a claim that will cause a denial is a failure to provide adequate information or providing erroneous information. Incorrect or omitted information may include names, addresses, birth dates, insurance information, sex or gender, date of the accident, date of the medical emergency, date of onset, among other potential factors.
Luckily, this mistake is easily preventable. To prevent this common error from taking place, check over all fields before submitting a claim. Be sure that everything is spelled correctly and that all required fields on your claim form are completely filled out.
2. Insufficient Data On A Claim May Cause Denials
In addition to missing information altogether, failing to provide an adequate amount of information on a claim may lead to a denial, or, at the very least, delay. Particularly, when a claim must be shared between multiple departments, if the information provided on the claim is not specific enough, it may lead to miscommunication or a need for a complicated follow-up.
For example, in a hospital setting, problems may arise if a billing department employee does not link a diagnosis code to the Current Procedural Terminology (hereinafter “CPT”) or Healthcare Common Procedure Coding System (hereinafter “HCPCS”) code or does not add a fourth or fifth digit to the diagnosis code; CPT and HCPCS are coding systems used in the healthcare industry that can be used to assist in insurance claims. For this common mistake, a simple solution is to code to the highest level of specificity possible. It would also be beneficial to discuss with your billers and coders so that everyone is on the same page regarding the specificity level that is to be expected.
3. Untimely Filings Cause Claim Denials
You are allotted only so many days to file a claim. Failure to file a claim in a timely fashion is a surefire way to have your claim denied. That being said, timely filing denials are arguably the most frustrating, as everything else on the claim may be stellar. However, this mistake can be easily avoided by keeping a list of general deadlines on hand.
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