When an insurance claim is denied, this means the payer can’t follow through with payment based on the information provided on the initial claim. Medical billing isn’t an easy process, and receiving denied claims adds extra pressure to an already stressful situation. The good news is, it’s possible to reduce the amount of denials you see. Hosting regular training sessions for your billing team, along with investing in a high-quality billing or NEMT software, are both great ways to combat denials. Additionally, understanding where claim errors most frequently happen makes a world of difference at your practice. Below, we put together a list of the top reasons NEMT and medical companies see denied claims.
Missing or incorrect information
It only takes one blank field or piece of incorrect information to result in a denied claim. This typically occurs because the biller didn’t review the claim before submitting, or because the proper information wasn’t collected at the beginning of a patient’s appointment. To avoid this problem in the future, gather all relevant patient and insurance information at the beginning of an appointment and consider finding reliable, comprehensive software for your practice.
Duplicate claims are ones that were submitted on the same date with the exact same information (provider, beneficiary, service performed, etc). If this happens, there’s no way for the payer to know whether there should be two different claims, if there were two separate visits and one claim has incorrect information, or if both were simply submitted in error. These claims will be denied and a provider will have to resubmit.
The service has already been adjudicated
This error happens when benefits for the service on the claim are included in the payment of another service that has already been adjudicated.
The service isn’t covered by the payer
This error simply means a patient’s insurance doesn’t cover the service they had performed. The best way to avoid this is by verifying up-to-date insurance coverage at the beginning of an appointment.
Time limit window expired
Most insurance companies give a window of time for submitting claims, starting after the appointment and typically ending a few months later. Of course, the sooner you file and submit the better. This denial can occur because staff had to make corrections multiple times or simply because the claim got lost and forgotten about. Both are unfortunate scenarios, but they happen. Having a central billing system, like reliable medical transportation software, will keep your claims organized and your deadlines in sight.
Combat denials with the right tools
NEMT software is, without a doubt, the best way to set your business ahead and kick claim errors to the curb. With technology on your side, it’s easy to view trips, passengers, schedules, dispatching, and billing data and deadlines all on one easy-to-use platform. When you’re ready to submit your claims, the system will scan everything for errors before they’re submitted to save you time and money by getting claims sent correctly the first time around. If you’re sick of billing denials, time-consuming manual trip scheduling, and losing money because of poor processes, give the RouteGenie team a call and see how our NEMT software can help your business.