3 Common Claim Rejections and How to Prevent Them

When you receive a claim rejection (for any reason), it delays your payment and requires additional work. Whether you’re billing a claim to a government payer like Medicaid or Medicare or a private insurer, it’s essential to your company’s success that you provide the correct and most current data available. 

When you receive a rejected claim, the 277CA Edit Lookup Tool is a great resource to help your team understand the edit codes that follow a rejection. This website tool gives you access to the Claim Status Category Codes (CSCC), the Claim Status Codes (CSCs), and the Entity Identifier Codes (EIC). In addition, it allows your team to make the necessary corrections to resubmit the claim for payment. 

3 Common Rejections with Solutions 

There are many reasons why rejections occur; the most common cause is missing or outdated information. Here are three of the most common data mistakes with solutions to help prevent errors from occurring.

#1 Patient Account and Sales Order Errors 

Incorrect patient account and sales order information, even one typo, can result in a rejected or denied claim. Make sure the following is correct before submitting the claim.

  • Patient account information
    • Date of birth 
    • Weight 
    • Gender 
    • Address 
    • The patient’s name is correctly spelled
    • Insurance information is current and includes the policy number 
  • Sales order information
    • Dx code per HCPC
    • Modifiers 
    • Quantity per HCPC
    • Narratives
    • Primary insurance isn’t included 
    • Data span 

Solution: If it’s a repeat customer, have all their information in your system. Then when they place their order, have them confirm the above details either through the computer screen or a printed copy. Have new customers enter their information electronically to prevent typos from occurring.

Additionally, stay up to date on any HCPC code changes that occur. You can review the latest 2021 HCPCS Code Update on A Celerian Group Company’s website here. Additionally, the Celerian Group Company provides valuable billing instructions and information that can help you with your sales orders here.

#2 Doctor Files Errors 

The most frequent mistakes from doctor files include:

  • Taxonomy 
  • License number 
  • Medicaid ID number 
  • Demographics 

Solution: You can confirm the doctor’s information using The National Plan and Provider Enumeration System (NPPES) NPI Registry. It’s a free system that allows you to search for NPPES medical professionals to confirm that their files contain correct information.

#3 Payer Files Errors 

The most common mistakes that occur within payer files are:

  • Electronic payer ID
  • Provider numbers
  • Doctor numbers and identifiers

Solution: Take advantage of available resources that allow you to confirm the above information is accurate, especially at the start of the new year when changes can occur. The NPPES NPI Registry is an invaluable resource for verifying providers’ data. 

Save Time & Money by Working with the Professionals 

Medbill is a top DME billing company in the country, whose team is 100% U.S. based, with a proven process that shows an ROI. Our team will help to guide you through the areas you need additional assistance with from document review, claims submission, accounts receivable, or cash posting. 

Contact us to learn how our services can decrease your claim rejections and streamline your revenue.