Resolving Claim Problems

In Lesson 8, we discussed claim problems and common claim codes, and how to resolve them. When claims are processed electronically, they go through multiple checks and can be rejected or denied due to coding or documentation errors. Common reasons for denial include incomplete information, typographical errors, data mismatches, coding errors, and documentation errors. To appeal a denied claim or reduced payment, the remittance advice typically provides instructions, and different payers have different processes for appealing. Knowing how to navigate the appeal process for each payer is important for resolving unpaid claims.