We reviewed top claim rejections in Q1 2018 from clients that are using TriZetto as their clearinghouse. While our clients, in aggregate, average less than 3% claim rejections (compared to 4% for all of TriZetto Clients), we found there is room for improvement.
- The COB information does not balance
- Claim Rejected as a same day duplicate
- No Trading Partner associated with this claim
- Payer ID Number is required and must be valid
- The COB information does not balance at the claim level
- The COB information does not balance at the service level
- Patient/Subscriber is not eligible please verify member ID/Insurance/Coverage
- Adjudication date required at the claim level or on all service lines for COB and tertiary claims
What we noticed was that several of these (1, 5, 6 and 8) can be resolved through a review of the CAS code configuration and a refresher on how to post payments to claims when there is more than one insurance on the claim. These errors are all related to not posting the CAS codes as CPT adjustments correctly, resulting in a claim going to the Secondary or Tertiary payer with incorrect information.
If your practice is struggling with these or other rejections, Curas can help with a short 2 – 4 hour training session focusing on your top rejections and how to eliminate them. Please contact us to learn more.