Identify each denial-management situation with its solution.
1. A claim that is not paid due to incorrect information must be corrected and sent to the payer according to its procedures.
(Click to select)
2. If a procedure that should have been paid on a claim was overlooked, another claim is sent for that procedure.
(Click to select)
3. If the payer has denied payment, the first step is to study the adjustment codes to determine why. If a procedure is not a covered
benefit or if the patient was not eligible for that benefit
, typically the next step will be to bill the patient for the noncovered
amount.
(Click to select)
4. A decision about the next action must be made. The options are to bill the patient, write off the amount, or challenge the
determination with an appeal. Some provider contracts
prohibit billing the patient if an appeal or necessary documentation has
not been submitted to the payer.
(Click to select)
