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Authorization Issues: Delays or denials due to lack of pre-approval for medical procedures or treatments, impacting timely patient care and billing processes.
Referral Issues: Challenges in obtaining necessary referrals from primary care physicians for specialist consultations or services, leading to access barriers.
Medical Necessity and Medical Records requests: Requests for additional documentation or justification for medical services rendered to meet insurance criteria for coverage and reimbursement.
Non-Participation with Insurance Network: Issues arising when healthcare providers do not have contracts with certain insurance plans, potentially resulting in higher out-of-pocket costs for patients.
Terminated Insurance: Problems encountered when patients’ insurance coverage has been discontinued, requiring alternative payment arrangements or financial assistance options.
Coordination of benefits: Complexities in determining primary and secondary insurance coverage, leading to delays or discrepancies in claims processing and payment.
Wrong Diagnosis: Instances where medical services or treatments are inaccurately billed due to coding errors or misinterpretation of diagnoses, affecting reimbursement and patient records.
Inclusive Procedures: Challenges in accurately coding and billing for comprehensive medical procedures or services that encompass multiple components or stages of care.
Partial Payments: Situations where insurance companies partially reimburse for medical services rendered, leaving patients or providers responsible for the remaining balance.
Out-of-network claim status and deductibles: Issues related to higher out-of-pocket costs for patients when receiving care from providers outside of their insurance network, including deductible requirements.
EDI Rejections: Electronic Data Interchange rejections due to formatting errors or inaccuracies in claims submissions, necessitating resubmission and potential delays in payment.
Letter of Protection from Attorney cases: Instances where patients have pending legal claims related to injuries or accidents, leading to special billing and payment arrangements contingent upon case outcomes.
No status and No claim on File: Challenges in tracking or resolving claims that have not been processed or documented by insurance companies, causing delays in reimbursement and financial reconciliation.
Workers’ Compensation: Issues related to billing and reimbursement for medical services provided to employees injured on the job, involving specific procedures and requirements.
PIP case: Challenges associated with Personal Injury Protection claims, including coordination with insurance companies and legal entities for medical expenses coverage.
Med Mission: Premier medical billing, maximizing reimbursement with integrity, excellence, collaboration. Expert coding, compliance, and payer management for client success.