5 tips to avoid rejected claims

The claims submission process can get tricky. Each health plan has a different process, sometimes multiple processes for each product line.

You already know that you can avoid claims denial by providing complete and accurate patient and provider information, including ICD-10, CPT, HCPCS codes. Here are 5 additional tips to help you get paid quickly.

Patient Eligibility: Verify your patient’s insurance eligibility for the date of service you're billing for. Coverage can change, and your patient’s insurance today may be different from the patient's health plan on the date of service you are billing for.

Covered Services: Not every plan has the same coverage or the same payment policies. Be sure to confirm that a service is covered by your patient's specific plan benefits.  

Benefit Limits: Some covered services have calendar or benefit year limits. Check the limit before you provide the service. Once the patient reaches their benefit limit, claims may deny for services billed after. 

Referrals/Authorizations: To avoid a denial, always request any required referrals/authorizations before the you provide a service. 

Timely Filing: Each health plan has their own timely filing policy (and some health plans have different timely filing limits across their product lines). If you miss the filing deadline, your claim will deny.  

AllWays Health Partners Claims Submission
We’ve centralized our claims information on a single web page. This page has claim mailing addresses, payer ID numbers, and customer service information by product line. Don't forget: the fastest way to get paid is to file your claims electronically through a billing agent or clearinghouse.