Billing: Recourse for denied claim? (after an approval)

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Alex Grant

• October 26, 2018 00:39

We recently had a therapist who input a lower amount of total units for care, so when the insurance company got the claim it was only for 1/4th of the services. She did not catch the problem until we received a check in the mail for a much lower payment than expected. We tried to re-submit those claims after updating them, but they were denied (not rejected). I am thinking this means that we have to accept the lesser payment since those claims had checks sent out; but wanted to confirm. Thanks for the info!

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  Gillian

  • October 26, 2018 00:47

  Hi, Alex. Have you reached out to the payer directly to inquire about the denials for the resubmitted claims?

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  Alex Grant

  • October 26, 2018 00:49

  I'm waiting to hear back. Has anyone on this forum seen this before?

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  Gillian

  • October 31, 2018 22:00

  Hi Alex, checking in to see if you've heard back from the payer - I'm sure others on the Forum would like to know as well. 

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  Alex Grant

  • November 01, 2018 00:06

  So far we have a response that implies these can be handled:

  "Previous billed claims will need to be billed as corrected claims to ensure they do not deny as duplicates."

  So we're looking into the corrected claims angle now.

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  Gillian

  • November 01, 2018 00:50

  Got it. Here's how to submit a corrected claim in SimplePractice:

  1. From your Calendar homepage go to Billing > Insurance > Claims tab.
  2. Open the claim that needs to be corrected and resubmitted.
  3. Click Edit to Resubmit.
  4. Next click Edit & Resubmit New Claim when this option appears.
     
  5. You can now edit the claim and make the necessary corrections.
  6. Next, scroll down to box 22 and make sure that the Resubmission option is checked.
     
  7. Finally, you’ll input the Payer Control Number in the Original Ref. No. field. The Payer Control Number is assigned directly by the Insurance Payer. This number will auto-populate to this field if a Payer Control Number has been received by SimplePractice. If a Payer Control Number has not been received, please input the original claim number that can be found on the EOB you received from the payer.

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  Alex Grant

  • November 06, 2018 00:55

  Thanks Gillian!

  we put in the corrected claim when they got back to us, and it looks like those got accepted.

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  Gillian

  • November 06, 2018 17:45

  Great! Glad to hear it. 

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