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Incorrectly Paid Claims

What is an Incorrectly Paid Claim?

Incorrectly paid claim definition: When a Medicaid claim is paid incorrectly, it means that providers are either underpaid or not paid for their reimbursements at all. In some instances, it means the patient becomes responsible for making the payment instead of the insurance company—and if the patient doesn’t have the funds to pay, NEMT providers are in trouble. It doesn’t take much to submit an inaccurate claim, but it can be difficult to fix afterwards.

medicaid billing assistance

Non-emergency medical transportation providers depend on Medicaid claim reimbursements to make their money. So what does it mean when a medical claim is incorrectly paid? When billing issues like this surface, it can become a serious problem for NEMT business owners— reprocessing claims takes weeks, or sometimes even months. That’s why having a software that eases the challenge of billing manually is crucial in avoiding incorrect payments.

Common Incorrect Payment Reasons 

There are two main reasons insurance claims are paid incorrectly:

Lack of eligibility
Incorrect billing codes

The wrong codes may pertain to a service the patient never received or the codes could have been duplicated. According to the American Medical Association, one in five medical claims submitted to health insurance companies are processed inaccurately. That number is far too high when providers depend on that money to keep their businesses going. Luckily, there’s technology available that helps ensure clean claims.

BillPro New York Medicaid software exists to ease the billing process. It allows providers to submit claims in a timely and accurate manner with proper coding. BillPro even tracks payments, so you know which claims have been reimbursed and which need follow ups. Rather than attempting to bill manually, it’s important that companies make the switch to an automated billing system to ensure accurate, clean claims and, in turn, receive reimbursements faster.

How to Handle Incorrectly Paid Claims

Receiving an incorrectly paid claim is frustrating, and rightfully so. Although it will take some time to receive proper reimbursement, it’s important to contact the insurance company quickly. The faster the problem is addressed, the faster you’ll have the right amount of money in your pocket. Follow these tips to dispute your billing errors:

Contact the insurance provider and explain the payment issue. Make sure you have the proper paperwork on hand to defend your case.

Keep a record of everyone you talk to at the company and of any important details expressed during the conversation.

Strongly consider investing in a Medicaid billing software like BillPro. This will guarantee fewer claim errors and make billing easier than ever for providers.

 Prevent Future Incorrect Payments

To prevent future wrong claim payments, NEMT providers should avoid manual billing. Commit to BillPro software and all the billing will automatically (and correctly) be done for you. BillPro is loaded with features that streamline the billing process like:

A system accessible from any internet-enabled device. Bill from the comfort of your own home or from your favorite coffee shop—no need to be tied to a desk chair!

An easy-to-use interface. You won’t spend hours trying to understand this simple software. Less time learning = more time billing for reimbursements.

A HIPAA-compliant software that recognizes New York Medicaid electronic payer ID and other essential data.

medicaid billing assistance

No more worries over incorrect codes or significant errors—BillPro intuitively knows the proper codes, state regulations, and other information for generating accurate claims. You’ll feel better about your business knowing that all claims will be accurately processed and paid on time.