curative guarnatee Claim Denials - 7 Steps to Get Them Paid

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Medical guarnatee claims are denied for all sorts of reasons. What do you do if you feel the guarnatee enterprise should have paid on a claim but has denied it?

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Having run a healing billing assistance for twelve years, we've see a lot of denials on claims. The biggest key to getting a claim paid when it is denied incorrectly is to act on it immediately. Sometimes in a busy healing office, there is a tendency to put a denial in a pile or drawer or take care of it later, but this is a mistake. The sooner the problem is dealt with, the more likely you are to get the decision reversed and the claim paid.

Here's how:

1. Look the denial over carefully. Look for a denial code that may be numbers or letters or a combination. Now crusade for the explanation of the denial codes, sometimes found at the lowest of the remittance. It may not make sense to you, but that does not matter. Right now you just want to know their imagine for denying the bill.

2. Once you resolve the guarnatee company's imagine for denying a claim, you have a good idea of what to do. If the imagine makes assuredly no sense, call the guarnatee company. There is commonly a phone estimate on the denial form. Calmly elucidate the situation to the buyer assistance representative. These representatives have to deal with calls like this all day, so it is much good to treat them respectfully. Remember, if a mistake was made, it wasn't this someone who made it; they are going to correct it for you. Be nice.

3. If you don't understand the imagine at all, call the guarnatee enterprise and ask for an explanation you do understand. It is very tasteless for an guarnatee enterprise to deny a claim incorrectly or because there was not sufficient information on the claim form. If they have denied the claim incorrectly, many times the representative can fix the problem while you are on the phone.

4. If you do understand the reason, but disagree, call the guarnatee company. elucidate why you disagree to the representative and ask what it will take to get this claim paid.

5. If the claim has been denied for a imagine which can be remedied, ask the representative exactly what you must do to correct the situation. If you are the outpatient or calling for the patient, this may involve calling your doctor's office and explaining to the billing boss what you have found out and request them to effect through.

6. The representative may tell you that the claim has been denied correctly. That does not necessarily mean that they will not pay. The claim may have been denied for timely filing. If the billing office resubmits the claim with proof of timely filing, the decision may be reversed. (Incidentally, if the claim is denied for timely filing, the outpatient cannot legally be billed.) The claim may have been denied for incorrect Id#. In this case, the Id# is corrected and the claim is resubmitted.

7. If you cannot get a solution to your problem with a phone call, it may be important to file a written motion to the guarnatee company. Ask the representative where you should send your written appeal. elucidate your situation entirely and the reasons you feel this claim should have been paid. Keep copies of all correspondence and notes of all telephone conversations. Write down who you spoke to, when it was, and what they told you.

Whether you are an individual trying to get your healing bill paid or you are from a doctor's office, make sure you keep good notes of everyone you talk to or write concerning the problem. This can be the key to getting your claim paid. If you are an individual, get the doctor's office complicated in helping you with your problem. Many times they know who to speak to or how to deal with the problem.

Copyright 2006 Alice Scott

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