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Results for “Claim rejections”

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Billing Operations

A Contract Was Sent, but Not Finalized: What We Check Next

When claims reject because a provider is not contracted, verify directly with the payer whether the contract was finalized, confirm its effective date, and identify affected claims. In a Blue Cross Blue Shield of Massachusetts case, we found that a contract believed complete had not been finalized; the payer later offered a temporary backdating path for a separate set of older claims.

  • Payer contracting
  • Claim rejections
  • Payer follow-up

Updated

Denial Investigations

Claim Rejection vs. Denial in Therapy Billing

A claim rejection generally means the claim was not accepted for adjudication. A denial reflects a payer's decision not to pay all or part of an adjudicated claim. Check the actual response before deciding whether to correct, submit again, or appeal.

  • Claim rejection
  • Claim denial
  • Payer response

Updated

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