At Billing Solutions Unlimited it is our job to minimize any coding and processing errors when filing claims. Our clients receive the majority of their revenue through the processing of successful claims. Our goal is to create long term and lasting relationships with our clients, we achieve this by being efficient and effective when managing a practices denied and rejected claims.
Denied -vs- Rejected
A denied claim is a claim that has made it through your claim scrubber and clearinghouse but is still not paid by the insurance company. The insurance company will list the denial reason on the Explanation of Payment. Typically, denials are caused by missing or incorrect patient demographics, coding issues or coverage issues. To correct these issues someone must follow the claims to make sure they are paid and if they are not the errors must be corrected and refiled to the insurance. Not being proactive with denials management can cost a practice to lose revenue.
A rejected claim is a claim has been rejected because of errors. These claims are never entered into the insurance company adjudication system and will need to be submitted as a new claim once the errors are corrected.
The process and function of denials management is essential to a healthy revenue cycle in any medical practice.