If one thing is true in the medical billing and coding space it’s that your organization will experience healthcare claim denials. Healthcare claim denials are so common that nearly 65% of denials are never reworked. There are so many variables involved with claim submission that your organization will inevitably be faced with healthcare claim denials.
If your organization does receive a healthcare claim denial, many insurance companies have established clearly defined deadlines for corrected claim resubmission. These deadlines are generally located within their provider manuals, often in the same section as their timely filing limits. So how do you make certain that your organization resubmits healthcare claim denials within the corrected claim resubmission deadlines?
Resubmit Healthcare Claim Denials within 30 days
1. Research clean claim resubmission dates
It’s not uncommon for healthcare insurance companies to have the same amount of time designated for both timely filing requirements and corrected claim resubmission deadlines. However, it’s not safe to assume that every healthcare insurance company operates the same way.
Your staff needs to understand the sense of urgency required with clean claim resubmission deadlines. Establishing a similar practice to how your organization keeps track of different timely filing deadlines will make clean claim resubmission easier.
2. Understand your most common denials
It’s important to view your healthcare denial landscape from a high-level so that you can determine your most common types of denials and which denials are the most costly on average. Once you have that information you can quickly determine which types of denials require your attention.
3. Establish streamlined front-end processes
As we know, some of the most common types of denials have a low overturn rate. Essentially, a low overturn rate means there is little to no chance that these denials are overturned even if you’ve cleaned the denial and resubmitted it within the deadline.
These low overturn healthcare claim denials are the result of poorly established front-end processes within your organization. However, this can quickly change with the help of technological assistance, effective training, and clear communication.
Although you will not be able to overturn these types of denials immediately, establishing streamlined processes on your front-end will result in fewer denials that can’t be overturned in the long run.
4. Don’t wait
If your employees wait to resubmit your claims when it is most convenient for them, they are delaying or suspending your organization’s cash flow. The claim review process should be comprehensive but establishing a sense of urgency within your organization will bring forth consistent cash flow.
A rule of thumb for claim resubmission is to always resubmit claims on a daily basis rather than weekly.
5. Review your claim correction process
Odds are that you already have a review process put in place to ensure that your claim submission is as clean as possible. However, when’s the last time you reviewed this process and are you certain that it is the best process available?
Manually reviewing and cleaning your healthcare claims, in most cases, is still a necessary step. However, there are certain technological advancements available that help streamline the claim submission process and ensure you submit more accurate claims within a healthcare insurance’s corrected claim resubmission deadline.