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Tips for Submitting Successful Claims...The First Time

Date: 04/16/18

Claim denials and rejections are frustrating, but there are steps you can take – and tools you can use – to reduce denials and rejections and get reimbursed faster. Put the following best practices and tips to work in your practice to help ensure you’re submitting claims correctly – the first time!

Tip 1: The foundation of successful claims is including the required billing information.

To ensure successful claim submissions and timely payment, all providers must have current, correct billing information on file. This includes:

  • Provider name
  • National Provider Identifier (NPI)
  • Tax Identification Number (TIN)
  • Physical address
  • Mailing address
  • Billing name and address

Remember: Always let us know when your information changes. This helps us make sure your patients can find you, your claims are paid correctly, and you receive any quality incentives you’ve earned! Click here to learn how to update your information.

Tip 2: Making sure your taxonomy is correct and matches the one on file with us is key to successful claim submissions.

All providers must have a taxonomy on file. If there’s no taxonomy on file, or if the taxonomy doesn’t match the one on file, the claim will be rejected. If you have multiple taxonomy codes, you must specify which one will be use. (This doesn’t apply to atypical provider types that don’t require an NPI.) If you need to update your taxonomy, there are 3 ways to do it:

  1. Send a letter of request on your company letterhead by fax to 1-866-768-9374
  2. Send a letter of request on your company letterhead by mail to: Louisiana Healthcare Connections, Attention: Provider Contracting, 8585 Archives Ave., Suite 310, Baton Rouge, LA, 70809
  3. Update it online at nppes.cms.hhs.gov and notify us by phone at 1-866-595-8133

As of May 1, 2022, Louisiana Healthcare Connections' address has been updated to: P.O. Box 84180, Baton Rouge, LA 70884. 

Tip 3: Learn how to avoid the most common denial reasons.

There are several common causes for claim denials. Learning what causes those denials can help you avoid them. Here are the top 3 causes of claim denials and how to avoid them:

  1. Service Not Covered (EX46): This means the service isn’t covered. Be sure to check the Medicaid Fee Schedule at www.lamedicaid.com to make sure the CPT/HCPCS code is covered, and check your individual contract to make sure it’s covered. You’ll also need to make sure the rendering practitioner is qualified to provide the services billed.
  2. Duplicate Claim Service (EX18): This usually occurs when providers attempt to bill a correction to a previously submitted claim. Make sure the appropriate frequency code/resubmission code is included in field 4 of the UB-04 and in field 22 of the HCFA 1500. You must also make sure the previous claim number you want corrected or reconsidered is indicated in field 64 of the UB-04 and in field 22 of the HCFA 1500. Remember, too, that requests for corrected or reconsidered claims must be submitted within 90 days of the date of denial, and that requests for reconsidered claims must include our Claim Dispute Form.
  3. Authorization Not On File (A1): This happens when there’s no authorization on file for the service billed. You can avoid this by making sure the practice or rendering provider is in our network, and that the authorization was requested and approved. Don’t forget to check that the claim matches the services and date span approved under the authorization. Remember, too, that it’s always best to use our free, online Pre-Auth Needed? tool to see if the service needs an authorization. You can also use our secure provider portal to request, verify and track authorization requests.

There are a few more very common denial reasons that you’ll want to be familiar with:

  1. Services not covered/coverage terminated: Remember, coverage can change at any time. Always verify eligibility every time services are provided. You can use our secure provider portal to verify eligibility, 24/7.
  2. Missing information: You’d be surprised how often missing information causes a denial. Be sure to check all claims for missed fields and make sure that any required supporting documentation is included.
  3. Coding issues: When coding your claims, make sure that what’s documented is what’s billed. Remember: If it’s not documented, it appears as if the services weren’t performed.
  4. Incorrect patient identifiers: Something as simple as transposed digits in a patient’s birthdate or a misspelled patient name can lead to issues with your claim. Make sure the patient’s name is spelled correctly, the date of birth and sex are accurate, the correct payer is entered, and the policy number is valid.

Tip 4: Use the tools available to you to help avoid claim rejections and denials.

We have many tools available to help you submit successful claims:

  • Secure Provider Portal: You can view and submit claims faster with our secure provider portal. It’s free and offers many additional functions – you can view/submit authorizations, verify patient eligibility, send us secure messages, view/manage your patient list, and assess timely data reports about your patient panel. You can arrange free, onsite portal training for your staff through your dedicated provider consultant.
  • Claims Audit Tool: Our Claims Audit Tool is customized to our system’s payment and clinical policies configuration. It allows you to input claims information, just like the Medicaid website tool, and it’s easily accessible in our provider portal. Just log into the portal, and click ‘Claims’ in the top toolbar, then select the ‘Claims Audit Tool’ tab.
  • PaySpan Health: This web-based solution for EFTs and ERAs is free for our providers. It will help you ensure faster payments and eliminates the need for re-keying data. Talk to your dedicated provider consultant about the other benefits of PaySpan and for help getting enrolled.

Tip 5: Exercise best practices when submitting claims.

Being proactive is the best way to make sure your claims are submitted successfully the first time. Incorporate these best practices to help reduce rejected and denied claims:

  • Review past claim denials and rejections to identify common errors that can be avoided.
  • Be diligent in double-checking your claims for clerical errors.
  • Communicate with others in your office to help avoid claim errors, coding errors and duplicate claims.
  • Stay current on billing and coding trends, like Risk Adjustment Coding.
  • Follow up promptly on claim denials and rejections.