Common Clearinghouse Rejection Codes in Medical Billing

1. Common Clearinghouse Rejection Codes in Medical Billing Causes & FixesWebsite:www.imedclaims.com Email:info@imedclaims.com

2. Introduction to Clearinghouse Rejections • Definition: Clearinghouse rejections occur when claims contain errors before reaching the insurance payer. • Key Point: Rejected claims can be corrected and resubmitted, unlike denied claims. • Common Causes: • Missing details • Duplicate claims • Patient/provider errors • Incorrect codes

3. Importance of Clearinghouse Rejections • Ensures Accuracy: Helps correct errors before claims reach the payer. • Prevents Denials: Reduces chances of insurance claim denials. • Speeds Up Reimbursement: Fixing errors early prevents delays in payments.

4. Common Clearinghouse Rejection Codes • Invalid Payer ID • Invalid or Missing Service Code • Invalid Date of Service • Invalid Place of Service Code • Invalid or Missing Procedure Code • Invalid or Missing Diagnostic Code • Invalid Patient Name & Address • Invalid Patient Date of Birth & Gender

5. Fixes for Common Clearinghouse Rejections • Stay updated with correct payer IDs and codes. • Ensure accurate patient and provider information. • Double-check CPT, HCPCS, and ICD-10 codes. • Verify date of service and place of service. • Use Electronic Health Records (EHR) for accuracy.

6. Conclusion & Best Practices • Verify all claim details before submission. • Stay up to date with medical coding updates. • Use automated tools and EHRs to reduce errors. • Train staff on proper claim submission practices.