Author Topic: Fixing denied claims  (Read 1031 times)

JWilliams

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Fixing denied claims
« on: November 12, 2008, 10:15:43 AM »
I just started working for this small MBC company and have only learned how to repair hospice claims and claims that need to be paid by another insurance company. My boss is telling me that I need to figure out how to repair all the other ones but I am unfamiliar with fixing claims. How do I figure out how to fix them with just the information from the EOB???

Michele

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Re: Fixing denied claims
« Reply #1 on: November 12, 2008, 08:40:19 PM »
When you say 'repair claims' I'm assuming you mean appeal denied claims, or correct them and reprocess.  It seems unreasonable that you boss should expect you to 'figure things out' but if that's what you've got to do then I guess you will have to see what you can do. 

Your question is actually kind of vague but I will try to give you some direction.  I would start with just one problem at a time.  Look at the eob for the reason codes to see why the claim was denied.  If you cannot figure out by looking at the reason codes, then call the insurance company and ask them to explain why the claim was denied.  Usually either by the explanation on the eob, or the answer you get from the phone call, will give you some direction to go with.  I can't possibly give you every scenario but you should be able to figure most out.  For example, if they tell you the claim was denied because the diagnosis is truncated, or not billed to the highest level of specificity, then you know you've got to look at the dx's on the claim.

Good luck
Michele
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