There Is Help. There Is A Solution.
Contact Us Today! 603-635-4149

Correcting clerical errors that lead to claim denials

Immediately after having received medical care from any hospital or clinic the Merrimack Valley, your physical as well as your emotional strength is likely somewhat drained. That lack of energy and mental fortitude can be even further compounded if you find out that your insurance claim has been denied. Many come to us here at The Law Office of Paul Petrillo worried about their mounting medical debt, only to later discover that their claim denials may only be due to simple clerical errors.

While claim denial rates from America’s major health insurance carriers have actually been shown to be quite low, those numbers only reflect final outcomes, and not necessarily the processes followed to reach them. Insurers use auditing software to screen claims as they are submitted. These programs look for technical errors in the billing codes assigned to a claim by healthcare providers. If an error is discovered, the claim may be automatically denied without any further review. Does this mean that your procedure was not covered? Not necessarily; a simple fix and re-submission might correct the issue. Exactly how many claims require such reworking? Information from the American Medical Association as shared by Forbes shows the percentage of claims that require reworking per insurer to be as follows:

  •          Regence: 20.49 percent 
  •          HCSC: 14.85 percent
  •          Anthem: 14.30 percent
  •          Humana: 7.57 percent
  •          Aetna: 7.13 percent

If your claim is denied, consider calling your insurer to see why. If they point out a coding error, you can contact your provider and simply request that the error be fixed and your claim resubmitted. Do not be worried about bringing up such clerical errors; after all, your doctor wants to see your claim covered as much as you do.

You can more information on dealing with medical debt by exploring our site. 

No Comments

Leave a comment
Comment Information

Law Office of Paul Petrillo
One Tara Boulevard
Suite 200
Nashua, NH 03062

Phone: 603-635-4149
Map & Directions

Google Map