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Identifying common claim filing errors

Like many of the physicians and practitioners in San Antonio that we here at The Law Office of Jessica Taylor, PLLC have worked with in the past, you rely heavily on insurance reimbursement to meet the operating expenses of your practice. That is why having a claim denied by an insurer can be so frustrating. The immediate response of both you and your staff upon receiving a denial may be to prepare a lengthy medical opinion in preparation for an appeal. Yet before you do that, your first step should be to check for simple filing errors that may have affected payment. 

In most cases, it is these simple errors that lead to denials. The website ACPInternist.org has prepared a list of some of the most common types of filing errors, as well as recommendations on how to avoid them: 

  • Incorrect subscriber ID numbers: Making sure that your front office staff asks to see a patient's insurance card at every visit ensures that the right subscriber ID is attached to a claim. 
  • Coordination of Benefits errors: Always ask if a patient is double covered, or if another potential payer (e.g., auto insurance, workers compensation) should receive his or her claim first. 
  • Diagnosis coding not matching coverage determinations: Compare the diagnosis assigned to national and local coverage determinations to see if the care provided meets medical necessity guidelines. 
  • Incorrect provider information: Make sure that the tax identification number, the national provider identification number, the employer identification number and place-of-service code on the claim are correct. 
  • Ineligible patients: Insurance pre-authorizations ensure that you know if a patient is still eligible for coverage. 
  • Duplicate claims: Always keep all claims submissions on file to avoid duplicates. 

More information on preemptively avoiding claim denials can be found here on our site. 

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The Law Office of Jessica Taylor, PLLC

The Law Office of Jessica Taylor, PLLC
14100 San Pedro Avenue
Suite 602
San Antonio, TX 78232

Phone: 210-265-6759
Phone: (210) 402-4022
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