If you have a higher percentage of health insurance claim denials in your organization than you are comfortable with, you’re probably long over due for a close look at what is driving these denials up – and I hate to be the one to tell you, but it’s not the payers!

Top 4 Tips in Reducing Claim Denials

Claims get denied for a variety of reasons – some of them are extremely simple to remedied, while others may require entire shifts in your organizational structure.

1. Make sure claims are legible (if submitting paper copy)!

A common reason is one that you may not even realize still matters in the world of electronic medical records: illegibility. There are some payers who are working in a partially or incomplete EMRs, therefore, they may be reliant upon paper claims. If the claims have illegible handwriting, misspelled words or other careless errors, the claim will likely be denied.

2. Make sure claims are coded accurately!

Another common error comes directly from the coding department – as a rule, claims should always be coded to the highest level of specificity. This means that the difference between a claim being accepted and denied could be one number within a code – if even a 0 is missing, the claim could be denied.

3. Check, double check, and triple check claims before submitting!

More complex issues may arise such as missing information. From time to time we’ve all been so swamped with work, or distracted, that we’ve made careless errors when filling out a form. Many forms that we work with day to day are repetitive, have small print, and fields are easily overlooked. It’s imperative that when filling out claim forms- either by hand or electronically – that all fields are checked and double checked for completeness before they are sent off.

4. Submit claims on time!

Similarly, the claim you send off could be pristine- everything coded accurately, completely, it’s totally legible – yet, if you send it off and it misses the necessary deadline, it won’t be accepted. Taking measures to ensure timely filing for all your claims may create some stressful deadlines, but if your workflow is adequate, then you should always be able to submit claims on time.

Of course, that being said, if you know you submitted a claim when you needed to and there was some kind of obvious SNAFU at the payer’s office, it is up to you to hold them accountable. Do not let them bully you into a denial if they were the ones to have disrupted the receipt of the claim!

If a claim has been denied for any reason, make sure that you take the time to look closely at it and not only validate the reason it was denied- but take the chance to inspect it further for any other possible areas of vulnerability that could lead to subsequent denials when it is resubmitted.