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clearing house

No one likes rejection - neither an amorous suitor, an eager job seeker, nor a presidential aspirant. But when it comes to love, employment, politics, or money, well, no pun intended, money trumps them all. And the root of your positive cash flow lies squarely in your ability to collect the revenue owed. Most provider revenue comes from third-party payers through the medium of claims. But occasionally, notwithstanding their best efforts to submit clean claims, providers may receive rejections due to undiscovered errors.

The key to turn those rejections into payments - quickly..

Electronic claims – Most claims clearinghouses have portals which allow you to easily identify rejected claims. In that view, billers can identify rejected claims and take action to correct them and resubmit the claim within the portal Paper-based claims – In those instances where providers must submit paper claims, a rejection may come in the form of an Explanation of Benefits (EOB) or letter. This is obviously the least preferable way to submit claims, but providers may not have a choice, depending on the payers. So here is the possible trap. Payers have front-end scrubbers used to detect errors. This takes place before the claims proceed to the adjudication system. Because this occurs up front, payers will likely not have a record of the claims scrubbed. So if a biller calls about the status of a claim, the payer’s customer support person may not even find the claim. When providers do receive rejection notices, these documents will describe what needs to be corrected.

The key to turn those rejections into payments - quickly..

Some of the most common reasons for rejections, more than likely resulting from input errors or having incorrect information in the first place, include the wrong payer ID number, member ID number, the wrong date of birth, a misspelled name, etc. Even claims clearinghouses may miss these errors

Tip: Identify the most common potential errors and include them in the triple check process “script”.
Documentation needed to correct errors


The biggest problem our team has observed over the years involves the preadmission and admission processes. Obtaining vital information ahead of time with the necessary documentation in hand is critical to verifying correct name spelling, DOB, address, member numbers, primary and secondary payers, etc.
A clearinghouse can display claims rejections which providers can view and correct.
The bottom line to avoiding the fiscal pains of rejection is to constantly monitor for them and to respond quickly with the correct information. Identify the most frequent causes of rejection and include them in your claims triple check process.

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