Claims correction refers to the process of identifying and correcting errors in submitted insurance claims. Claims correction is essential to ensure accurate and timely payment from insurance companies and prevent claim denials or underpayments.
Here are some common reasons for claims correction:
- Data Entry Errors: This includes mistakes in patient demographics, provider information, diagnosis and procedure codes.
- Coding Errors: Medical coding errors, such as assigning incorrect CPT codes or ICD-IO codes, can result in claim rejections or incorrect reimbursement.
- Missing or Incomplete Information: Claims that lack necessary documentation, such as supporting medical records or prior authorization, may require correction to include the missing information.
- Coordination of Benefits (COB) Issues: When patients have multiple insurance policies (e.g., primary and secondary insurance), issues can arise in coordinating benefits correctly. Claims may need to be corrected to account for the correct order of payment.
- Billing Errors: Mistakes in calculating the amount billed, such as failing to apply contractual adjustments or discounts, can result in overbilling or underbilling.
- Claim Rejections: Claims that are initially rejected by the insurance company due to various issues, such as invalid patient information or lack of medical necessity, may require correction and resubmission. This is where incorrect use of modifiers are seen.
The process of claims correction typically involves the following steps:
- Identification of Errors: Heartland Claims Consulting reviews claims from EOBs or ERAs that have been rejected, underpaid, or contain inaccuracies. We identify the specific errors or issues that need correction.
- Correction: Once errors are identified, the necessary corrections are made to the claim. This may involve updating patient information, modifying codes, attaching missing documentation, or resolving coordination of benefits issues.
- Resubmission: The corrected claim is resubmitted to the insurance company for processing.
- Follow-Up: Heartland Claims Consulting follows up with the insurance company to track the status of the corrected claim, address any further issues or requests for information, and monitor the reimbursement process.
Claims correction is a crucial component, as it helps healthcare providers maximize their reimbursement, reduce claim denials, and maintain accurate financial records. Timely and accurate claims correction ensures that providers are reimbursed for the services they render to patients while complying with insurance company requirements.