Question of the week: Can you appeal a claim rejection?
The answer to this question is "No." You cannot appeal a claim rejection. The reason is that a rejection, by definition, has not been adjudicated by the payer.
The claim gets rejected at the clearinghouse and has never made it to the payer, or has been rejected by the payer without being adjudicated.
The claim gets rejected at the clearinghouse and has never made it to the payer, or has been rejected by the payer without being adjudicated.
There are several reasons a claim may be rejected but the most common cause is incorrect data including missing or incorrect demographic or insurance information, incorrect or mismatched HCPCS and ICD-10 codes, and missing or invalid provider NPI numbers. Other common reasons for rejections include duplicate claims and eligibility.
Establishing a workflow to identify rejected claims, correct the information, and resubmit the claim is essential. If your practice identifies a trend leading to rejected claims, work with your team to address the root cause of the problem.
Learn more about preventing claim rejections and denials in my Front End Denials Decoded course.
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