4 Most Common Pain Points of Insurance Claims

Posted by Andrew on February 10, 2020

Payers and providers are often at odds when it comes to filing insurance claims. While payers want clean claims free of errors, providers want prompt payment. These aren’t always adversarial goals, but frustrations and errors can happen if a payer or provider is hasty while processing a claim. Errors can take a while to fix which costs both parties in resources and time as they rework the claim.

Of all the challenges providers have to navigate while processing claims, the following are the most headache inducing:

  1. No or slow information from the payer. Following any service, providers code the claim and submit it to their payer. However, waiting for an update can be a long process that leaves many providers wondering when or if they’ll receive payment. As a result, many providers follow up frequently, which takes up valuable time.
  2. Claim denials. While a denial at least lets providers know where they stand in the claims process, it’s not the update they were hoping to receive. The denial process is often murky as payers aren’t always clear on the reason why they denied the claim.
  3. Vague feedback. Continuing with the above point, payers return claims unpaid for a variety of reasons, but they always include a code as to why. However, these codes can be vague and frustrating for providers such as claim/service lacks information. Without any specification as to what is missing, providers have to hunt and guess for the reason.
  4. Rules are different for every payer. Even if the services that providers offer never vary from person to person, the method of coding differs among payers. This makes it challenging to navigate the claims process as one payer may consider a submitted claim clean while another may reject that same claim. Compounding the problem, rules change often with little notice, which can muddle claims as well.

Improving communication between payers and providers can help reduce rejected claims and expedite payment for services. However, submitting clean claims the first time around is also critical to saving time and reducing hassles. Implementing a full service claims management program can help achieve that goal. Contact the experts at Actec to learn more about improving claim management.