Six Tips for Handling Insurance Claim Denials

    by Communications and Corporate Relations & Business Strategy Staff even practitioners who take precautions to avoid policy payment pitfalls sometimes find themselves faced with a claims abnegation. Handling denied policy claims can be a thwart, time-consuming and complicate process for practicing psychologists and their administrative staff.

    Knowing some basic strategies for resolving claims denials can save practitioners fourth dimension and improve their commit ’ s cash flow. Some basic pointers for handling claims denials are outlined below .

  1. Carefully review all notifications regarding the claim
    It sounds obvious, but it ’ south one of the most important steps in claims processing. When you receive a remittance advice, explanation of benefits, or other presentment from an insurance company regarding a claim, review it cautiously.

    The presentment should indicate whether the call was paid in full moon, delay, partially paid or denied. If the claim is determined to be “ dirty ” or contested, follow the carrier ’ second instructions for resubmitting the claim along with any missing or corrected information. ( tip off : For pointers on submitting clean claims, read “ Insurance Claims 101 : keep off Common Payment Pitfalls. ” ) If the claim is partially paid or if requital is denied, the telling should specify the reason ( south ) and outline the specific procedures and documentation required to resubmit the claim or file an entreaty.

    If the telling is not gain, call the carrier for more information. In addition to eliciting a declared argue for denying a claim, you may find out that the call was adjudicated falsely because of an administrative error on the function of the payer. You might besides discover that your submission procedures do not match the caller ’ s requirements but that you can make some dim-witted adjustments to your procedures to streamline future claims submissions .

  2. Be persistent
    If your resubmitted claim is denied and you believe the defense was improper, you may appeal the decision according to the carrier ’ second guidelines. Make sure you know precisely what information you need to submit with your appeal. Keep in mind that entreaty procedures may vary by policy company and state police.

    Your appeal should include an explanation of your reconsideration request, along with any necessary load-bearing documentation, such as a copy of the claim in wonder and copies of earlier communication to the company about the topic. If your claim is denied on the grounds of “ medical necessity, ” you may need to submit extra information to demonstrate necessity. Be aware that it is all-important to meet your obligations under the Health Insurance Portability and Accountability Act ( HIPAA ) to protect psychotherapy notes and to provide only the “ minimum necessary ” information.

    You may need to resubmit the claim or file an solicitation more than once to reverse a ship’s company ’ mho decisiveness, but don ’ t give up. Your continuity can demonstrate to the insurance company that you are serious about resolving the problem and getting paid.

  3. Don’t delay
    It is crucial to submit and resubmit claims in a timely manner, within the timeframe specified by the company or the applicable laws in your state. otherwise, the claim may be adjudicated based merely on the information you already provided, or any requests for reconsideration or invoke may be denied as prematurely.

  4. Get to know the appeals process
    When you submit an appeal, make certain you are familiar with the company ’ randomness appeals process. When you know your carrier ’ s policies, you are in a better status to respond to the carrier ’ mho actions. Keep stream data regarding the claims adjudication and solicitation processes for each carrier with whom you work. Carriers often include this information on their websites and, if applicable, provide arduous copies of the information each clock you sign a new contract with them .
  5. Maintain records on disputed claims
    When you call an policy company for more data about a claim, keep a commemorate of the information you are given, along with the fully name of the congressman with whom you spoke. Store this data with other key information about the claim, including : why the claim was partially paid, delayed or denied ; the actions your office took to follow up on the claim ; and the result.

    These records can play in important function in future actions, such as taking your appeal to higher levels, submitting complaints to the express policy commissioner and/or pursuing subsequent litigation. The records can besides serve as a helpful charge of sample appeals letters and documentation that can aid your office in avoiding or resolving future claims denials .

  6. Remember that help is available
    While handling claims denials can be a torment process, it can save you time and money in the long run by alerting you to the expectations and requirements of the policy carriers you condense with. By ensuring that your bill procedures are consistent with the company ’ s requirements, you may be able to reduce the occurrence of rejections and denials in the future. however, if you continue to encounter reimbursement problems with a particular insurance company, contact your express insurance commissioner ’ randomness function for aid.

    For extra pointers related specifically to Medicare claims, see “ How to Avoid and Handle Medicare Claim Denials. ”

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