Rejected Medical Claim Recovery Australia
A rejected claim does not always mean the billing process is over.
DEVZ Solutions helps specialists identify rejected and unresolved billing items, understand the available rejection information and undertake appropriate administrative follow-up.
Why Medical Claims Get Rejected
Medical claims can be rejected for different reasons.
Services Australia identifies examples including:
- Incorrect claiming information
- Patient or provider eligibility issues
- Maximum benefit limits
- System issues
- Additional information being required
- Issues associated with the submitted item or claim information
A rejected claim therefore needs to be investigated rather than simply resubmitted without understanding the reason.
Medicare and ECLIPSE Return Codes
Medicare Online and ECLIPSE can return codes that provide information about why a claim was rejected or how it was assessed.
These messages can help identify claiming errors, corrections that may be required and whether further action is appropriate.
DEVZ Solutions can use the available claim information and return messages as part of the administrative investigation process.
Our Rejected Claim Workflow
The administrative process may include:
- Identify the rejected or unresolved claim.
- Review the available rejection or return information.
- Compare the issue with the supplied billing information.
- Obtain additional information where required.
- Make appropriate administrative corrections where authorised.
- Resubmit where appropriate and permitted.
- Monitor the claim after resubmission.
- Reconcile the resulting payment or outcome.
Not Every Rejected Claim Can Simply Be Resubmitted
The appropriate response depends on why the claim was rejected.
Some issues may be administrative.
Others may involve eligibility, clinical information, MBS requirements or payer rules that require practitioner review or further information.
DEVZ Solutions does not alter clinical information or independently determine services that were not documented or authorised by the treating practitioner.
Preventing Rejected Claims From Being Forgotten
One of the risks with rejected billing is not merely rejection itself.
It is allowing unresolved claims to remain unnoticed.
A structured billing workflow helps identify items requiring attention and ensures appropriate administrative follow-up can occur.
Official Information
Have Outstanding Rejected Claims?
DEVZ Solutions can review your existing billing workflow and help identify outstanding administrative items requiring follow-up.
Rejected Medical Claim FAQs
Why does Medicare reject medical claims?
Claims can be rejected for several reasons, including incorrect claim information, eligibility issues, benefit limits, system issues or because additional information is required.
What is a Medicare or ECLIPSE return code?
Return codes provide information about errors or claim assessment and can help identify what action may be required.
Can a rejected claim be resubmitted?
Some rejected claims can be corrected or resubmitted where appropriate, but the correct action depends on the reason for rejection and applicable claiming requirements.
Does DEVZ Solutions change clinical information to make a claim pass?
No. DEVZ Solutions manages billing administration based on clinical and billing information supplied or authorised by the practitioner.
Can DEVZ Solutions review old rejected claims?
DEVZ Solutions can assist with reviewing outstanding billing administration and identifying items where appropriate follow-up may still be available.