Let’s all agree that claim denials are frustrating.
Often the reasons for claims denials are relatively simple.
Below are the top 3 reasons we see denied claims and how you can easily fix these errors.
1. NPI and TAX ID: Start at the beginning with your own NPI and TAX ID. If these key numbers are not on file with CENTIPEDE and your health plan then… bingo your claim won’t match the system and you’ll receive a denial as an out of network provider.
Do not use an NPI or TAX ID that was not used in your Credentialed file.
Tip: Ensure your NPI and or TAX ID change are on file with CENTIPEDE and we will notify all health plan’s accessing CENTIPEDE.
2. MEMBER NAME: Next, ensure that you have the correct and EXACT Name, Address and Date of Birth for your member that is on their ID Card.
Jack Smith is not the same as John B Smith.
Member names must be exact, take a moment to validate the name, address and date of birth on your authorization or Member ID Card.
3. DIAGNOSIS CODE: Last but not least, ensure that you have a valid Diagnosis Code with the correct number of digits. A helpful link to locate valid diagnosis is https://www.icd10data.com .
The key to clean claims starts with accurate data.
Develop a checklist and ensure that the basics are right on all of your claims.