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Rejected Claims

medicaid billing assistance

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. Luckily, there’s usually a pretty simple fix, and with the help of BillPro, you’ll have far less rejected claims for a much smoother reimbursement process.

What is 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:

Billing validations

Clearinghouse validations

Payer validations

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If you receive a rejected Medicaid claim, don’t panic. Take a look at the explanation provided in the pamphlet, correct the error, and resubmit the claim.

Common Rejection Reasons

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:

Сlerical errors
Mismatched procedures
Invalid ICD code

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.

How to Handle Rejected Claims

Your insurance claim was rejected—what next?

First, read the explanation provided with the rejected claim.

Compare the report with the details of your policy to see if the reason holds up.

If you believe the claim shouldn’t have been rejected after checking your policy, but you aren’t sure how to fix it, call the insurance provider and explain your concerns.

If the error is a simple change, fix your claim and resubmit it.

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.

medicaid billing assistance

Prevent Future Rejected Claims

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. Don’t stress yourself out trying to bill everything on your own—our automated solution will make billing easier than ever with fewer claim rejections and faster reimbursements!