Anesthesia Coding Alert

Question: When we know that the carrier has made a mistake in denying a claim, can we simply resend the original claim again, or will the carrier just deny it again without further review?


North Dakota Subscriber

Answer: Although simply resending a claim that the carrier erroneously denied sounds like a logical, easy answer, in the end it might cost you more time and effort. The carrier denied the claim for a particular reason during the first round of submission. If you don't address that reason, the carrier will likely return the claim to you as a denial again.

Possibilities: Many things can go wrong that will result in an erroneous denial. Problems with patient pre-authorization, physician credentials with the carrier, a claim oversight on your part, or problems with the carrier's processing systems could all cause an incorrect denial.

Good practice: Rather than automatically resending the claim, contact your carrier representative. Discuss the denial with the representative, and figure out why the carrier denied the claim. A short phone call could save you much more time in the long run.