subject: Medical Billing Service - An Answer To All Sorts Of Claim Failures [print this page] These days, the administrative work of each and every business is tangled with complex legal formalities and failure to follow means, attracting attention of concerned federal agencies. True said, let the expert do the job because relying on a novice for cooking fried rice is like breaking the ice in perfect size, either he will not be able to do it or he will mess it up. In case of medical facilities or centers, the scenario is somewhat same; medical staff found themselves incompetent of handling other hectic jobs like insurance claims, beside their routine work and finally they end up at a professionals office who can provide him medical billing service pertaining.
Every time we step in a health care centre or G.Ps clinic, before even being treated (in most cases); we are instructed to follow the insurance claim forms and formalities. These stacks of forms then becomes a headache for the medical staff and becomes a headache for us too when they insurance companies holds the reimbursement for some reasons. There are four grounds, on which basis your payments will be kept on hold and those are as follows:
Pended Claims: this is the first ground on which reimbursements are put on hold and the reason stated is, erroneous information; a information when entered in the computer system of New York State Department of Health responds as, Not matching. In some cases, where immediate medical condition knocks up, mistake with filling forms is quite a general thing. In most cases, these claims are reviewed and resolved at the tables of Department of Health or Computer Sciences Corporation, a fiscal agent of The New York state Department of Health.
Denied claims: this is the second ground on which your reimbursement can be stopped and the basis that supports these sorts of claims is, a services obtained, which is not in the list of New York State Medicaid Program. There are few other ground on which a claim will be denied and those are:
A duplicate of prior bill
If the bill misses the required prior approval
If the data entered or filled in invalid
If the data entered is logically conflicting.
Rejected claims: the third ground comes here is, rejected claims. A claim will be considered as rejected, if either the information entered is omitted or somewhat wrong, the claimer will be asked to re-lodge the application after removing the found error.
Missing claim: as name states, these are the claims which somehow never make their way to the office and lost their destination somewhere in between. In other words, missing claims are those, which never reach insurance claim office. In such cases, only new original claims will be processed and CSC will not accept any carbon or photocopies.
