WHAT IS HEALTHCARE CLAIM DENIAL?
The detailed invoice of claims that your doctor sends to health insurer and you get a service from healthcare provider and claim according to your plan benefits. When the insurance company refuses to give you benefits according to your plan then it is called Healthcare Claim Denial. Here is a drop list of 5 main things to avoid so that your health claim will not be denied.
1. Missing Information:-Sometimes when we submit our information to insurance companies, it might occur that the information is missing or not in proper manner. Even the one field left blank or there are some missing modifiers, wrong plan codes or incorrect or missing social security number can lead you denial of the claim.
2. Don’t submit duplicate information:-When one person submits claim more than once for the same service then their health claim will be denied. Either the claim is submitted to same beneficiary, same encounter on same date to same provider then the claim is denied. So one should take care of these claims related things so that they would not face that problem.
3. Unbundling of services:-Unbundling of services means when services are not included as a part of extensive procedures provided at the same time. This may include benefit of services included within other service or procedures so that people find it difficult to unbundle as a result Health Claim is denied. So to avoid this situation the claim should be bundled and properly stacked so that people will read all documents carefully.
4. Check details properly:-Before taking the benefits of the services go through all paper work as well as all the insurance related documents carefully so that there will less chances of claim denial.
5. Utilize automated software:-Making the use of automated software’s will help you to avoid from the situation of denial of claim. Utilize the automated software instead of asking from external venders to optimize claim management system.
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