Rejected claims may be the result of flawed procedures, ICD codes or clerical error
Non-emergency medical transportation companies deal with Medicaid billing every day, which means problems are bound to surface.
Medicaid programs vary from state to state, so the process can be complicated and frustrating - especially when you receive a rejected claim.
Rejected claim definition: a claim that is currently filed under a rejection status.
A rejected claim doesn't necessarily mean that the claim is unpayable, just that important information is missing or inaccurate.
A claim will be rejected if it fails one of the following:
Clearinghouse validations
Billing validations
Payer validations
Rejected claims contain one or more errors that were located before the claim was processed or accepted by the payer.
The main reasons for rejected claims are:
Additionally, you may have waited too long to file the claim, or the insurance company may have lost the claim and it expired.
These aren't the only reasons for rejected claims, but they're common ones and they're fixable.
The best way to initially prevent rejections is by assessing patient eligibility - front-end staff should validate a patient's demographic information, health insurance status, and coverage before submitting a claim to ensure a smoother path to an approved claim.
Overall, the best way to prevent rejected claims is by using New York BillPro Medicaid software. With more clean claims, you’ll save time and you’ll be reimbursed faster.
Unfortunately, rejected claims are common.
They can become a serious hassle for NEMT companies, but investing in BillPro will reduce the inaccuracies and complications that come with billing Medicaid claims.