How To Troubleshoot Rejected Claims

In this video, we will talk about how to

troubleshoot

rejected

or denied

claims

within Collaborate MD. Let's start before locating rejections or denials. Let's review the claim lifecycle to understand the different points at which a claim can fail after you create and submit the

claims

and it is submitted. to the Clearinghouse upon receipt the claim is vetted through thousands of clearinghouse edits assigned by the payer, if no errors are found the claim is sent to the payer where they will adjudicate the information to verify the data missing or incorrect, they will proceed with the adjudication process and respond.

With an e OB or ER a there are three basic steps to the life cycle of a claim submission and processing adjudication and payment or denials the claim can fail during any of these steps submission and clearinghouse processing close the clearinghouse identify an error they will reject the claim preventing it from being sent to the payer, these types of rejections are called Clearinghouse exclusions, adjudication by the payer's EDI, if the payer finds any error they will reject the claim and return it to you, they are identified as peer-generated rejections, denials If a billing error is found after the payer processes the claim, it will be marked as a denial and included in the document I B o era now that we fully understand the life cycle of a claim and where a claim can be

rejected

or become a rejection, let's review how to locate these rejected or denied claims we will start with the rejected claims panel here you can see a list of rejections received in the last seven days clicking on the rejection message will display the list of associated claims within the claims tracker if you would like to see a list of just your clearinghouse exclusions consider using the rejected claims in clearinghouse report this report will show all claims that have been rejected by the clearinghouse within a Specific date range If you want to see all your expelled and denied claims in one place, it is best to practice to use the claims tracking feature Enter your criteria and then click search Check the box Expand all to quickly view the messages status of your submitted claims.

Rejection messages are identified with a red exclamation point. Let's take a look at some examples. Let's start with a clearinghouse. Rejection first we can see that this claim was not sent to the payer because the ICD code is not valid. This claim rejection indicates that the member was not found. This refers to the insured in the claim. You must verify the insurance member number or date. Alternatively, you can compare eligibility with the patient's record to validate member information. The last example shows a denied claim. We received an ER and a list of remittance codes indicating that this charge was denied because a payment has already been made.

It is also important. Please note that most of these rejection messages come directly from your peers' EDI, so they may differ in wording between different payers. Once you understand the reason for the rejection, be sure to correct the error within Collaborate MD, for example, if the claim was rejected due to an invalid error. provider NPI number update that NPI within the provider section if the claim was denied because the insured member ID was incorrect perform the update from the patient account and update the applicable claims or if the incorrect ICD code was used open the claim and select the correct code After the claim is corrected, the next step is to resubmit the claim, see our video on how to resubmit rejected claims or help articles for step-by-step instructions.

There we present a quick tutorial on how to

troubleshoot

rejected claims. Claim denials make medical billing and coding challenging, but with CMD we make it easy to get step-by-step instructions, FAQs and other instructional videos in the claims section, visit our knowledge center, take action and help dr. Bray MD comm thanks for watching