Helpful Tips for Preventing Claim Delays

Over our many years of managing and billing for ASCs, we have compiled a list of the most common issues that cause delays in claims processing.

Here are several tips to keep in mind when filing claims:

• Verify benefits with third-party payers. This can be helpful prior to submitting claims or appeals. It will provide you with the most current contract information, if prior authorization is required, as well as any benefit exclusions that may be relevant to the services rendered.
• Obtain a copy of the patient's current insurance card at each date of service, as insurance coverage may change. This will help ensure that claims are submitted to the correct carrier and with the most current contract information.
• If applicable, verify the correct letter prefix is present on all outgoing claims. This is extremely important. Many claims cannot be processed without this prefix.
• If a corrected claim is needed, for a 1500, enter the number 7 and the original claim number in box 22 "Resubmission Code." On a UB04, enter the number 837 in box 4 "Type of Claim." If the corrected claim is not marked as such, it may be denied as a duplicate or the issue may not be resolved appropriately.
• Include all current and complete provider information on the claims, including the current tax identification number and NPI numbers in the correct fields.
• If you do not receive a response to a claim in a timely manner, check with the payer for claim status prior to resubmitting the claim. In most cases this can be done through the carrier's website. If the claim is already on file but not processed, a resubmission will not expedite the processing of the original claim.