DENIED CLAIMS

Denied claims occur when a payer has processed and considered a claim unpayable due to a vital error.

What is a denied claim? What does it mean when a medical claim is denied?

For starters, a denied claim doesn't mean your claim isn't payable.

But it does mean there was some sort of vital error that deemed the claim unpayable.

It can be scary to receive a denial, it's important to understand what it means if your Medicaid claim is denied, and what you should do to solve the problem.

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UNDERSTANDING DENIALS

WHAT IS A DENIED CLAIM?

Denied claim definition: a claim that has been received and processed but marked "unpayable," usually due to an error or lack of prior authorization.

Sometimes a claim is flagged because of missing information or even because a service isn’t covered under the specified plan.

The good news is, these claims can be corrected, appealed, and sent back to the payer for further review.

Unfortunately, this can be a time consuming process.

That’s why the best way to prevent these mistakes from happening is with New York BillPro, which checks for errors before a claim is processed and decreases the chances of Medicaid claims being denied.
WHY WAS YOUR CLAIM DENIED?

COMMON DENIAL REASONS

You’re probably wondering, 'Why was my insurance claim denied?" claim denials mainly occur for a few reasons:

  1. a claim violates contract terms, like patient eligibility issues;
  2. contains vitals error;

Examples of such errors include incorrect patient, provider, and insurance information and incorrect or mismatched codes.

While mistakes happen and sometimes details are overlooked, NEMT providers can avoid denials simply by using BillPro for faster processing times and error-free documentation.

WHAT HAPPENS IF YOUR CLAIM IS DENIED?

HOW TO HANDLE DENIAL CLAIMS

A denied Medicaid claim doesn't necessarily require immediate action, but you should address the issue in a timely manner since payers only allow a certain window of time to receive corrected claims.
Once you've reviewed the denial, prepare a list of questions and look over your policy and summary of benefits and coverage.
When you're prepared, contact the insurance company and explain the situation. If it's only a small error, the problem may be solved on the spot.
However, if it's something bigger, you may need to file a formal letter, which can become time consuming.
COMBAT DENIALS WITH THE RIGHT TOOLS

PREVENT FUTURE DENIED CLAIMS

No one likes wasting precious time - and denied insurance claims do just that.

Non-emergency medical transportation companies want to be paid as quickly as possible, so having an accurate, efficient billing software like BillPro is the best route to success.

When you invest in BillPro, you’ll receive faster reimbursements - and since the system is fully automated, there will be fewer errors and less denied claims.

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