Medical coding is a complex process that varies for every procedure, patient, and insurance provider. While no billing department is immune to claim denials, they can avoid several common mistakes to reduce the frequency of them. These include:
- Missing information. Claims need to be as specific as possible to avoid a denial. Any missing piece of data can result in a rejection. However, the most common missing details are the date of the medical crisis, the date of onset, or the date of the accident. Avoid this mistake by examining the claim for any missing fields.
- Incorrect patient information. Similar to missing data, incorrect patient data can result in a claim denial. The most common examples of incorrect information include misspelled names, inaccurate date of birth, sex, insurance provider, and policy number. Double-checking the patient’s information for accuracy can avoid this kind of claim denial.
- Referral required. Some insurance providers require patients to receive a referral or prior authorization before receiving certain medical services. If a primary care doctor sends a patient to another physician for advanced medical tests or specialized treatment, he or she may have to issue a referral while the payer issues a prior authorization. However, receiving prior authorization doesn’t guarantee coverage. If the payer determines the services weren’t medically necessary or if the claim wasn’t filed on time, the payer may still reject it.
- Claim filed too late. Continuing with the above, providers must submit claims within a certain window. For Medicare patients, this is of particular importance. The Affordable Care Act reduced the claims submittal period from 15-27 months down to one calendar year. This means from the date of service (the from date on the claim), providers have one year to ensure the payer receives the claim. This means if the provider submits the claim before the end of the calendar year, but the payer receives it after the one year date, the payer can deny it.
- Eligibility issues. Insurance terms and coverage change often, so it’s vital to verify eligibility before receiving a service. For example, a patient may be eligible to receive physical therapy following an accident, but only for 12 weeks. If the patient meets their maximum benefit, the payer can deny any claims extending beyond that amount.
Keeping errors to a minimum is critical for successful claims management. If your claims management system is causing several errors and delays, contact the experts at Actec. Our full cycle claim and incident reporting solutions can help you close claims quickly and efficiently.
There are only so many hours in a day, but clients don’t care about their insurer’s workflow problems. They want answers to their questions, rapid resolutions for their claims, and quick payouts for settlements. While insurance companies can’t make the day any longer, they can optimize their existing procedures to improve efficiency. The following are several ways to improve the claims management workflow.
Insurance companies run any number of ads to try to lure new customers; however, retaining customers is just as critical for success. The best way to keep customers loyal is during the claims process. When a customer files a claim, they are often in a vulnerable state. They likely experienced a loss of some kind (i.e. car accident, theft, etc.) and need their insurance company to help them through the process. If their experience is less than satisfactory, customers may begin looking for a new insurer.
Improving the claims management process does more than improve customer satisfaction. It also improves employee efficiency, which allows insurance agents to close more claims on a faster timeline. Whether adjusters have years of experience and are learning new technology or they are new professionals that are used to automated software systems, any insurance agent can benefit from the steps outlined below.
Homeowners submitted record high claims this year after several severe weather incidents wreaked havoc across the nation. However, their overall satisfaction with the claims process was at a record high. Insurers are able to do so with improved communication. While many believe faster claims resolution improves customer satisfaction (it does), stellar communication can make it even better. This is because insurance representatives can manage the customer’s expectations for a timeline to resolution.
Technology has forever changed how insurers interact with their customers. However, this is not always to the benefit of both parties. With increased online interactions (i.e. quotes, claim submissions, payments, etc.) came a rise in fraud. While banks and retailers have taken the lion’s share of negative press, the auto insurance industry is just as susceptible to cybercrime and fraud.
Several factors are driving change when it comes to First Notice of Loss (FNOL). Before sophisticated technology became commonplace, first notice of loss was almost universally initiated via a phone call. Now, policyholders can log onto their computers or phone apps to trigger FNOL. Although this change seems monumental, it is nothing compared to the latest trends looking to shake up the industry.
Insurers catch most instances of fraud after they already paid for the claim. However, it is harder to get money back from a fraudulent claim than it is to prevent fraud in the first place. This was not always the case. With the rise of powerful analytics, insurers can use the data to make predictive models. These models can trigger an investigation into a claim if it contains markers of previous cases of fraud. This will allow insurers to stop fraud before paying the claim.
The auto industry is no stranger to technology. Automotive technology has allowed for drastic improvements in driver safety as well as increased connectivity. With the rise of telematics, first notice of loss (FNOL) underwent a significant transformation.