Common Roadblocks to Care

Insurance is Unable to Process Your Claim - Errors that may delay the claims process -

Sometimes your medical claim is unable to be processed at the time of submission, which is different than a full denial. In this case, the insurer will identify a reason why the claim can not be processed and include instructions on how to resubmit. Reasons may include:

• Insurance information submitted with claim was incomplete

• Lack of pre-certification or prior authorization, if required

• Diagnosis and/or procedure codes were missing or incorrect

• Incomplete or inaccurate information on claims

• Lack of medical documentation showing necessity of service During the process of dealing with a resubmission or completion of claim paperwork, take careful notes on who you speak to and what action is taken. Follow up through the entire process to ensure completion and that your claim is paid without undue delay.