Insurance claim denials can be one of the most frustrating aspects of the billing cycle. Providers often don’t know exactly why a claim was denied, but the impact on your revenue cycle can be profound. Unfortunately, a large proportion of denied claims never get appealed, and the revenue they could have generated is simply lost. In many cases, these denials are based on errors that could have been corrected. To avoid this destructive pattern of denied insurance claims and lost revenue, reach out to RevWerx today. Our team of experts is standing by to help streamline your insurance claims management system. Call us at 833.309.0138 or reach out online to get started.
Why Most Insurance Claims Denials Occur
There are a variety of reasons claims may be denied, and issues can occur in multiple parts of the insurance claim process. Here are a few common reasons claims may be denied:
- Patient Error: The patient failed to update you about a change to their insurance. In this case, the claim was denied because the patient is no longer covered by the insurer you have on file.
- Provider Error: Your insurance claims management staff incorrectly entered a part of the patient’s information when filing the claim. Unfortunately, something as simple as inverting two numbers in a patient’s member ID number can result in claim denial.
- Provider Included Insufficient Documentation: Insurers may deny claims on the basis that “medical necessity” of procedures or services has not been demonstrated.
- Insurer Made Changes: Sometimes, insurance companies assign new ID numbers to their members or change the alphabetic prefix associated with these ID numbers. If your patient is unaware of this change or forgets to update you, using the outdated version of their ID number can result in claim denial.
- Insurer Error: The insurer may have made an error if you receive a message that a claim was “denied for no coverage or coverage terminated,” but the company paid claims occurring both before and after the one it denied. In this case, the patient’s information is likely up-to-date, and the error is more likely on the insurer’s end.
Handling Insurance Claim Denials Through Better Insurance Claims Management
When it comes to dealing with denied claims, getting results means getting organized. The clearer your system is for handling denials, the more likely your appeals will result in payment. Similarly, the better organized your insurance claims management process, the more likely you’ll avoid future denials.
In the meantime, here are a few tips for handling claims denials:
- Read and Resubmit Carefully: Many errors are procedural. If you receive a denial or only partial payment, read the insurer’s explanation carefully for any instructions on resubmitting the claim and documentation required. To increase the likelihood of successful payment, follow directions to the letter.
- Check for Errors: A very common reason given for claims denial is “no coverage or coverage terminated.” If you receive this message, visit the insurance company’s website and look up your patient by name and date of birth to see if there has been a numeric or alphabetic change to their member ID.
- Call the company: This is a great next step to take after verifying that the patient’s identifying information is correct. Especially if claims have been paid before and after the one that was denied, it’s possible the insurer simply made an error in denying the claim.
- Contact the patient: If you cannot resolve a denied claim by reviewing information that you and the insurance company provided, it’s time to contact the patient. Call or write to them requesting that they update you on any changes to their insurance.
- Provide Additional Documentation: In the case of claims denied because the procedure or service’s “medical necessity” was not demonstrated, more information is needed. You’ll need to gather and submit additional documentation according to the requirements the insurer provides you. However, be careful to remain in compliance with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA requires that providers protect patients’ privacy by sharing only the “minimum necessary” information about treatment with insurance companies.
Partner with RevWerx to Optimize Your Insurance Claim Process
Avoid insurance claim denials in the first place by partnering with RevWerx. Our revenue cycle management services include claims management, utilization reviews, in-house billing implementation, aging collections management, and more. With our assistance, you can consolidate workflows, so claims are handled as efficiently as possible, eliminating much human error. We’ll also help you take advantage of technology. Automation is one of the best ways to avoid claims denial, and we’re standing by to help you update your information technology systems. Call RevWerx today at 833.309.0138 or reach out online to streamline your insurance claims management today.