What should a billing specialist do upon receiving a claim denial?

When a billing specialist receives a claim denial, reviewing the denial reason and resubmitting the claim is the proper course of action. This process involves carefully analyzing the denial codes and notes provided by the insurance company to understand the specific reasons a claim was rejected.

By addressing the issues highlighted in the denial, the billing specialist can make necessary corrections or gather additional information that may be required to support the claim’s validity. After these adjustments or enhancements are made, resubmitting the claim with the corrected information increases the likelihood of approval.

This approach not only ensures compliance with procedural necessities but also maximizes the chances of payment, thereby improving the efficiency of the billing process and the financial health of the healthcare provider. Ignoring the denial, re-submitting unchanged claims, or just informing the patient without taking corrective action would not effectively resolve the issue at hand, which underscores the importance of reviewing and addressing the specifics outlined in the denial.