Hi there, I had a question about denied claims. Let's say I sent out a claim on a date of service of 06/01 to a health insurance that has a timely filing of 90 days. If they deny the claim, do we only have until 09/01 to fix the claim and send it back? Or since we originally sent it out before then, the 90 days resets to the denial date? Thank you!
Do you have a video on how to fix Medicaid error for example r03, G55 or ad1 I am new to the Medicaid world I am more so commercial now I am doing Medicaid something I just don't know how to fix the rejected error or is there somewhere I can find something or a book
We don't, but we will add that to our list! We are working on videos again, so hopefully it won't be too long a wait for us to cover your topic. Just keep an eye out!
You're very welcome! :-) Hope all is well with you! Let me know if there are any other healthcare billing/admin questions that I can help answer for you.
I wish my hysterectomy was denied almost a year ago. My doctor misdiagnosed me with endometriosis and he pushed me to get the hysterectomy based on false symptoms and diagnosis 😢. My pathology result showed only two uterine polyps 😢
Hi there, I had a question about denied claims. Let's say I sent out a claim on a date of service of 06/01 to a health insurance that has a timely filing of 90 days. If they deny the claim, do we only have until 09/01 to fix the claim and send it back? Or since we originally sent it out before then, the 90 days resets to the denial date? Thank you!
Hi Robert! Sorry for the delay. With a basic claims filing limit you have 90 days from the Date of Service to get the claim into the insurance carriers system for adjudication (processing). For example, if the claim was sent but rejected at the clearinghouse level and you didn't refile (resubmit) until after the 90 days your claim will not be paid. There is also a timely filing for appeals and reconsideration of claims and that is the timeframe to send in an appeal from the date of the original EOB. That date is tycially different from the claims filing limit.
@@InleraU Thank you! I've learned so much more from watching your videos than I have from my managers at my job as a payment poster and medical biller!
'COB Denials' some payer has the information that member has another primary insurance but they dont have a clear information about that ig: may be that payer has already terminated. Can you please advise @@InleraU
Yay!! Thanks 🤩 I’m so happy that you found it valuable. Please do let me know if there are any other videos you would like me to make that could help the team on the front end of the revenue cycle i.e. the front desk, verifications & etc.
Rejected claim can be appealed? Actually I asked insurance to reprocess a rejected claim,but audit team gave an error to me . Thy are asking me to appeal it. How can a claim can be appealed without denial...? I think reprocess is the best way for rejection.. I kept rebutal on this to auditor Kindly hlp me on this
That is correct. They misinformed you. Rejected claims cannot be appealed as appeals can only be submitted for claims that have been accepted for adjudication. You can and should correct the claim and submit it with the proper claim frequency code as either "corrected" or "replacement" claim. I hope that helps!
You are so very welcome! Thank you for your willingness to learn! :-) Let me know if there is topic, in particular, you would like to know more about in the business of healthcare.