Navigating The Health Claim Maze – In the first two articles (Part 1 and Part 2) we looked at what it takes to counsel someone in private practice to file an insurance claim after being identified with an insurance company. In this post we will look at what to do if an insurance claim is denied or denied.

First of all, understand that if you have things set up well to begin with and you work well on the front end, claims denied or rejected are usually minimal. The most common reasons for claims being denied or denied are missing or incorrect information on the claim. For example, the customer’s insurance policy or membership number is incorrect or digits are missing.

Navigating The Health Claim Maze

As mentioned in previous articles, one way to avoid the problem of missing or incorrect information on the front end is to use a clearinghouse to file your claim. The clearinghouse “scrubs” the claim for errors and notifies you of what is missing or incorrect before sending the claim to the insurance company. However, sometimes claims are still denied or denied.

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The good news is that you can usually find out why a claim was denied or denied by reading the EOB (Explanation of Benefits) that the insurance company sends by mail or electronically. There will usually be an explanation code or message giving the reason for the rejected claim.

After you find out why the claim was denied or rejected, you can correct the claim and resubmit. To do this you will need to call the insurance company to see if they have a special code for resubmitting an amended claim. These are entered in Block 22 with the original claim number found in the EOB or Clearinghouse.

One strategy used by many physicians and counselors in private practice is to select a few major insurance companies to identify in your area. This way you are focusing on only those insurance providers that will pay you quickly and at a reasonable rate.

Also I highly recommend that you look into outsourcing your insurance billing and claims. For example, hiring a virtual assistant or medical billing company to handle your denied or denied claims. For me, having access to my EHR (Electronic Health Records) and clearinghouse systems is completely remote. He checks them weekly for any claims that need follow-up. He then bills me for the time spent.

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Other models collect a percentage of the collection. I prefer to hire him on an hourly rate basis. But you can make the best decision for your business model.

Dealing with denied or rejected claims is a “pain”. But once you learn some of the nuances of the various insurance companies that you are in network for, the incidence of denied claims will decrease.

Other great resources: The Insurance Answers Podcast The Insurance Billing and Credentialing for Mental Health Clinicians Group on Facebook

L. By Gordon Brewer, Jr., MEd. LMFT – Gordon is President and Founder of Kingsport Counseling Associates, PLLC. He is also a counselor and business consultant in the practice of therapy. Follow us on Twitter @therapistlearn. Join the Facebook group.

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Other unclassified cookies are those that are being analyzed and have not yet been classified. The benefits and healthcare ecosystem is complex and, as a result, often difficult for employees to navigate. In fact, since the start of the pandemic, 86% of employees say they have found it challenging to navigate and use their employee benefits plan.

Here’s the bottom line: You can put together a stellar benefits package for your employees, but if they struggle to understand, navigate and use it, engagement and satisfaction will decrease. By providing benefits navigation support as part of the employee experience, employers can:

As you define your navigation strategy, use this checklist to make sure there are key areas your employees need help covering.

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There are many pieces to the healthcare puzzle, and navigating between each can be a challenge. From different providers to insurance carriers and benefits vendors, employees can feel like they’re constantly being bounced around. Here are some ways you can make the process easier for them:

Making the right care decisions requires a lot of thought and research. Here’s how you can help your employees get the information they need to make informed decisions for themselves and their family members:

We all know that finding a provider that fits our unique needs can take some time. Here are some ways you can help your employees navigate and narrow down the right provider options:

Using benefits can come with a whole host of administrative tasks and coordination that can often be complex and time-consuming. Here’s how you can intervene to make the administrative side of healthcare easier for your employees:

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As the utilization of healthcare services is expected to be high this year, it is necessary for employers to provide navigation support in this way. Work with a vendor that can provide an all-in-one navigation and enrollment solution to help you deliver a better care experience to your employees and get better results for your benefits package.

Provides leading navigation services through Health Advocate. Navigation Advocate leverages both digital and telephonic tools to help employees successfully navigate their complex benefits ecosystem, improving engagement and satisfaction with their benefits program. Through seamless integration with technology platforms and service centers, employees can access unlimited healthcare and benefits support, 24/7.

For more than 20 years, Health Advocates has been helping to simplify health care for thousands of organizations across the country and millions of their employees and members. Health Advocate’s solutions leverage a unique combination of expert-led, compassionate support using powerful predictive data analytics and a proprietary technology platform to engage members in their health and wellness. Health Advocate members enjoy award-winning, personalized concierge service that addresses nearly every clinical, administrative, wellness or behavioral health need. Customers can benefit from higher levels of engagement, improved employee productivity and reduced health and medical costs, while streamlining and enhancing their health benefits offering. For more information and limitations that may apply, visit

Articles — January 9, 2023 Top 5 HR Trends of 2023: 2023 In 2023, technology will continue to play a major role in how we adapt. Here are five trends we’re seeing. Articles — December 12, 2022 Our Holiday Gift to You: Lessons Learned in 2022 2022 has been a dynamic year for HR. With the transition to the post-pandemic workplace, there are several trends that companies are following.

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