The 5 Most Common Mistakes That Get Your Claim Rejected
It may seem like a lot of paperwork to file an insurance claim, but it’s essential to do it right if you want to receive the support you need.
We’re here to guide you through the five most common mistakes that could lead to your claims being turned down.
Learning about these slip-ups can increase your chances of having a successful claim and getting the support you’re entitled to.
1. Inaccurate & Incomplete Information
Sometimes people unintentionally give the wrong information about what happened or the damage.
This can make the insurance company doubt your claim and say no.
Be truthful and accurate when filling out the claim forms.
Tip: Make sure your billing staff double-checks frequently missed fields, such as the patient subscriber number, and corrects any errors before submitting your claims.
2. Not Reporting Timely
In the process of filing a claim, timing is important.
In case of an incident, failing to report it as soon as possible can compromise your chances of claiming compensation.
Insurance policies require claims to be reported within a specified time frame after the event occurs.
It could be construed as negligence or an attempt to manipulate the situation if a claim is not filed in a timely manner.
To avoid claim rejection, always follow the reporting timelines outlined in your policy.
Tip: Set a reminder to report any incidents as soon as possible after they occur.
3. Lacking Sufficient Documentation
Insufficient documentation can be another big reason for claim rejections.
When you file a claim, you need to provide supporting evidence to validate your request.
Like photos, reports, and receipts – these can help you show the insurance company what went down.
Not having enough evidence can make claim seem like a made-up story.
Tip: Keep all the papers and pictures organized in one place.
4. Exceeding Coverage Limits
Every insurance policy comes with coverage limits – the maximum amount your insurer will pay for a claim.
Exceeding these limits is a common mistake that can lead to rejected claims.
It’s important to understand the policy’s coverage limits and make sure your claim falls within them.
The remaining expenses will be your responsibility if your claim exceeds the limit.
Tip: Review the policy documents to clearly understand coverage limits for different scenarios.
5. Not Being Specific Enough in Your Claims
Making your codes as specific as possible is the best way to avoid claim rejections.
When assigning a diagnosis code, make sure to use the code with the most digits possible.
For instance, if a code can have five digits, make sure you use all five. If you send a code with fewer digits, you might receive a rejection.
Tip: Encourage communication between your billing and coding teams.
Some billers might not have extensive coding knowledge, so it’s important to educate them about what shortened codes look like. This way, they can catch any issues before sending out the claim.
By removing these common mistakes, you’re giving your insurance claims a better chance of being accepted.
You don’t have to handle insurance claims alone. Let AR Rescue assist you.
You can get help from our friendly team to guide you through the process.
Make your insurance journey easier by getting in touch with us today.