Clean claims submitted on a consistent schedule are key elements to maximizing your practice’s financial stability. At Health Data Solutions, your claims will go through a rigorous "scrubbing" system that looks at coding, code combinations, local coverage determinations, and specific payer rules. It's a "smart" system that continually learns from the alerts, denials and feedback from payers that it receives. Right now, our system checks your claims against 3.5 million known edits... that's 3.5 million ways that an insurance company can deny your claim. The result? More of your claims get paid on the first-pass.
Just a few examples of edits:
Code needs a modifier... or doesn't need the modifier that's on there
The diagnosis code on the claim doesn't support the service that was rendered
The procedure code is inappropriate for the age of the patient... or the gender.. or.....
The procedure code is normally accompanied by another procedure code but it's missing
Two procedures listed aren't normally performed together
The date of injury is missing on a Comp claim
The "accident date" is missing for Blue Cross
Coverage termed or dependent not eligible
And 3.5 million more, many of which are payer-specific......