Eligibility Denial

Which step should be taken first to resolve a claim denial due to patient inactivity?

• Resubmit the claim immediately

• Contact the insurance company for clarification.

• Verify the patient's insurance coverage.

• Inform the patient about the denial.

   

What action should be taken if the patient's insurance coverage was inactive on the date of service?

• Appeal the denial with the insurance company

• Adjust the date of service to a time when the patient was active.

• Check for any other active insurance/ plan for the patient

• Resubmit the claim.

Which department is primarily responsible for verifying patient insurance coverage?

• Eligibility and Benefits verification team

• Medical records department

• Front desk staff

• Accounts receivable department

What could be a consequence of not addressing claim denials promptly?

• Increased reimbursement rates from insurance companies

• Improved patient trust

• Reduced administrative workload

• Delayed revenue for the healthcare provider

Tags

CCSS.RI.11-12.3

CCSS.RI.11-12.5

CCSS.RI.8.5

CCSS.RI.9-10.3

CCSS.RI.9-10.5

If the claim with date of service - 05/01/2023 is billed to insurance and the patient's policy was effective from 05/15/2022 and is still active then will the claim be denied for coverage terminated?

• Yes

• No

Denial PR 26 and 27 are same?

• Yes

• No

Is CO-31 same scenario as Member is not active on DOS?

• Yes

• No

Can we bill the patient if there is secondary insurance active on DOS?

• False

• True

What can we also name Patient is not eligible on DOS scenario?

• Coverage is not effective

• Member is not active on DOS.

• Expenses incurred prior to coverage.

• All of the above.

What information should be checked to ensure the patient's insurance coverage is active?

• Name and date of birth

• Insurance policy number

• Coverage effective date and termination date

• a)      All of the above