Claim processing can be complicated by a number of different issues. At HLS, we can resolve all of these issues by tracing the root cause of the denial. If the claim denies for coordination of benefits, we can sort out which payer is primary and submit the claim to the responsible payer, including resolving conflicts between two or more payers about which of them is primary. If the claim denies for a billing error – invalid procedure codes, dates of service, levels of care, etc. – we can research the error and either submit a corrected claim or ask the payer to reprocess the claim correctly. We can also ask the payer to reprocess the claim if they’ve improperly underpaid based on the applicable fee schedule, network status, or coverage requirements.
Interested in learning more about how HLS’ claim cycle solutions can deliver the results you’re looking for? You can contact us and we’ll be happy to provide you with more information.