Claim Submission and Claim Rejections
Sending a reimbursement request to an insurance provider for medical procedures or other service is claim submission. Healthcare providers or healthcare services submit a claim to know how much reimbursement they will receive after the insurance company pays its dues. For a claim that has been submitted, if an insurance company refuses to process a claim due to errors in policyholder’s documentation, terms or procedures, rejection of claim occurs. The reason for rejection is usually informed to the policyholder.
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Instapay Healthcare Services’ Claims Submission and Claim Rejection Management
Claim submission process involves transferring claims data from the revenue cycle management (RCM) system to a clearinghouse entity. This is all done with managing any returned or rejected claims. Claim scrubbing procedure helps identify and correct issues with the claims that are to be submitted. It leads to ensuring that all the inaccurate information is rectified by our expert medical billers before the submission.
Claim Submission Process
Patient Registration: Gathering patient information such as demographics and medical history
Insurance Eligibility Verification: Checking if the patient has an active insurance plan and that they will be covered for the treatment.
Charge Entry: Submission of charges for medical services and other patient-facing services.
Managing Pre-Authorization Requirements: Submitting a pre-authorization form for planned treatments
Payment Posting: Posting the payment to the patient's account after the insurance company pays the claim.
Reporting and Analysis: Generating reports on claims processing metrics to identify areas of improvement.
Claim Denial Management Process
- Analyzing the reason for denials.
- Determining the cause of the denial. Insurers usually provide an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) with details on why the claim was denied.
- Appeal the denial through gathering supporting documents and facts.
- Tracking the results to monitor the appeal.
Components of Instapay Healthcare Services’ Claim Submission and Rejection Management Process
- Timely updates to handle exceptions or issues.
- Quicker turnaround times.
- Batch processing from the RCM system to the clearing house.
- Parsing of claims to payer systems with needed corrections.
- Claim rejections management and handling the necessary adjustments.
Claim Rejection Reasons
- Information given is false, incomplete or undisclosed.
- Policy has expired.
- Claim filed after the given time limit.
- Unfulfillment of complete medical tests and history from the insurance policy.
- Policyholders didn’t add or update the nominee details in their insurance policy.
If a claim is rejected, policyholder is allowed to resubmit the claim in revised format with additional but accurate information.
Instapay Healthcare Services’ Best Practice for Denial Management
Constantly conducting performance audits.
Timely submission of claims without any delays, as and when services have been rendered.
Monitoring performance metrics.
Streamlining internal workflow.
Upkeep with healthcare trends in denial management.
Transparent communication with all parties involved.
Benefits of Our Claims Submission and Rejection Management Process
We, at Instapay Healthcare Services’ work proactively towards claims management to resolve any issue, reduce the likelihood of claim denials. Clients who work with us benefit from:
- Improved turnaround time increases productivity, and leads to greater accuracy
- Minimized claim denials lead to higher and quicker reimbursements
- Extensive documentation maintenance of all business rules
- Daily support calls for real-time issue resolution