Resolved CPB

[TennaS_52681]

I am studying for my CPB exam this month and there is a question that I can't find a answer on so can you please assist me with this question?

**What can make a full batch reject?
Thank you
Tenna

 

[Lori]

Claim Rejections​

Claims Rejections are claims that do not meet specific data requirements or basic formatting that are rejected by insurance according to the guidelines set by the Centers for Medicare and Medicaid Services.

These rejected medical claims can’t be processed by the insurance companies as they were never actually received and entered into their computer systems. If the payer did not receive the claims, then they can’t be processed.

This type of claim can be resubmitted once the errors are corrected. These errors can be as simple as a transposed digit from the patient’s insurance ID number and can typically be corrected quickly.

It could be many different things that affect a claim but a bulk reject usually means you may have the same error on the entire batch for example:

Just leaving one required field blank on a claim form can trigger a denial. Incomplete information like wrong plan code or no Social Security number.

Incorrect Patient Identifier Information.

• Patient name
• Date of birth
• Sex
• Insurance payer
• Policy number
• Group number (if required)
• Patient’s relationship to the insured
• Primary insurance (in the case of multiple insurances)

Or

• Missing or Invalid CPT or HCPCS Codes. ...
• Referral or Pre-Authorization was Required or Expired. ...
• Medical Services Excluded from Plan Coverage. ...
• Claim Was Filed After Insurer's Deadline. ...
• Insufficient Medical Necessity. ...
• Use of Out-of-Network Provider
• Wrong demographic information.
• Verify insurance and eligibility.
• Duplicate claim.
• Incorrect place of service

Please also see this thread for more on denials:

Denials