Revenue Cycle Decoded's Question of the Week - Claim Rejections

claim rejections medical billing question of the week Apr 11, 2023
Question of the Week

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 payor. The claim gets rejected at the clearinghouse and has never made it to the payor.
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.