In the ever-changing world of health care, providers are often overwhelmed with the amount of paperwork they must file. One of the most important documents they file for patients is the Claim Form.
If a claim form is not completely filled out, i.e., if a field is left blank, or if there is incorrect information filled out (such as date of birth, ss #), the claim will most likely not process. Unfortunately, many times the insurance company does not reach out to the provider to request the missing or correct info. As a result, the claim is left in a “pending” state. In the meantime, the patient assumes all is well, until they receive a bill from the provider showing that nothing was paid on their claim.
Patients often assume the insurance company has denied the claim, not realizing it can be related to the scenario described above.
We recommend that members call their insurance company when they have an unexplained unpaid claim. If they find out it is pending for missing or incorrect information, they should call the provider’s billing office to be sure the claim is re-filed with the corrected information. Once this is done, the claim should process in a timely manner.