Question

Your supervisor has given you a number of rejected claims and asks you to determine why the claims were denied and to maintain a log of these reasons to be discussed at the next team meeting. How will you proceed with this assignment?

Answer 1

I will list the rejected claims details and determine the reasons by studying each one. A separate file will be created for each claim with patient ID information including name, date of birth, date of admission/visit, disease condition, whether pre-existing or not, reason to claim, the reason to reject the claim, insurer and insurance details, etc. Any claim form errors will be checked for and corrected. Then any missing information will be included in each one. Any coding errors will be noted accordingly. Claim filing date and time will be noted as well to check whether the rejection was based on this. Other details like policy period, premiums, out-of-network provider etc. Finally, a table will be created with all rejection reasons and all other relevant information to make the discussion much easier and less time-consuming. A log will be created for each reason, which will be discussed in the next team meeting.