Magazine article Behavioral Healthcare Executive

5 Ways to Ensure Clean Claims

Magazine article Behavioral Healthcare Executive

5 Ways to Ensure Clean Claims

Article excerpt

When it comes to filing insurance claims, a lot can go wrong. Coding errors and accidental omissions can ultimately delay payments to providers. Therefore it's important for all stakeholders involved to strive for "clean claims" that are processed the first time around instead of the second or third.

Claims adjudication is meant to be an automatic function that accepts the claim, sorts the data with algorithms and then renders payment. Any uncertainty in the operation will cause a claim to be kicked out of the automated system and either denied outright or sent into a manual queue. Manual processing is more costly and time consuming.

In an effort to improve this processes, Behavioral Healthcare asked industry experts to weigh in on what providers are doing wrong and offer advice on what they would consider best practices for filing claims. Administration also needs to know how to best navigate a denial if it should occur.

Here are five tips for making sure your claims are clean and that your payments are rendered promptly.

1 Use technology to your I advantage

I Dawn Muller, executive director, I Aetna Behavioral Health Operations, says filing electronically and signing up for Electronic Funds Transfer are two ways to help expedite the payment of claims right off the bat.

"Currently, the majority of providers bill electronically and receive reimbursement through Electronic Funds Transfer," says Muller. "Paper claims have not completely diminished yet, but they will continue to fade out over time and eventually become rare."

Looking ahead, she says, there will be increased use of technology for contracting, claims payment and benefit quoting, as well as widespread use of electronic medical records. Providers should be prepared to abandon paper entirely.

2 Make sure all data fields are correct

Although coding errors vary, Muller says providing an invalid diagnosis code or an invalid member identification number are the two most common data field mistakes. Providers also frequently submit claims that are incomplete, she says.

Another common reason for claims denial is inaccurate information, says Janna Aiken, director of billing operations for American Addiction Centers.

"Make sure all information is correct, such as location of services-inpatient or outpatient-spelling of name, date of birth, address, insurance policy ID number and group number," she says.

She adds that it's important to doublecheck to ensure that diagnosis codes and authorization numbers match the level of care billed. …

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