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Clearinghouse rejected claims

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  • Official comment
    Monika

    Hi Ellen,

    I wanted to clarify a bit regarding what happens when a claim is rejected. Rejections usually happen prior to claims processing and can come from our clearinghouse, a third party clearinghouse, or the payer. Rejections usually stem from discrepancies in the member or billing provider details where our clearinghouse or the payer could not locate the member or billing provider in their database based on the information provided. Since the rejection happens prior to the claim being entered into the payer's adjudication process, it's not uncommon that payers are unable to locate the claim as it is not in their database.

    In this case, it's best if we take a closer look at the claim(s) in question, so I've created Help Request. We'll reach out via email shortly.

     

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