Claim Resolution

Our system provides rejection reports the day after a claim is submitted electronically.  Once we are in receipt of any rejection our staff begins to research and correct.  We also review all EOB’s for denials.

Common rejections/denials include:

*Eligibility issues-we will research eligibility before asking your staff for additional information

*Invalid Medicare number-many Medicare claims are being rejected due to errors entering the new

  Medicare numbers-we will research and correct these errors

*Medicare beneficiary is enrolled in an HMO plan-we will research and obtain the correct payer 

  information.

*Modifier issues-we can correct these and add the appropriate modifiers when necessary