decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Claims Filings - Returned Claims / 9 ways to flub your claim
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Article Overview
This article explains common claim-submission issues that can cause a payer to return a claim for missing or incomplete information. It is aimed at billing, coding, and practice staff who handle paper or electronic claims and want a high-level understanding of the administrative areas involved, including physician referral information, diagnostic test payment fields, group practice identifiers, primary payer details, and supporting documentation.
Why This Topic Matters
Returned claims slow reimbursement, increase rework, and can create avoidable denial-management burden. Understanding the broad submission areas discussed here helps staff spot incomplete claim records before filing.
What You Will Learn
- Common categories of claim-filing errors that can lead to returned claims
- Which claim fields are discussed in relation to missing or incomplete information
- How payer-specific documentation and identifier data can affect claim acceptance
- The administrative areas involved in Medicare-related and primary-payer claim submissions
Who Should Read This
- Medical billers
- Medical coders
- Revenue cycle staff
- Practice managers
- Claims processors
Modifiers Discussed
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