Tired of your reinsurance claims reimbursements being held up?According to our research, the top 3 reasons for reimbursements to be pended are:

1. Accident details – This can easily be avoided by scanning the diagnosis on the claims for patients who may have claims related to an injury (usually the diagnosis begins with an 8 or E). This should be done at the 50% reporting level in order to allow time for the paperwork to get back to you for submission when the claim exceeds deductible.
   
   
2. Itemized bills – When filing claims electronically, sometimes the reports do not include all revenue codes for a particular admit. Usually, just some minor tweaking of the report programming fixes this problem. If not, print the screen of the electronic UB92 or have an actual copy of the UB92 accompany the filing.
   
   
3. Description of Services – Health Plans often utilize miscellaneous codes or internal codes for certain medical services. Provide a list of those codes along with their descriptions to your reinsurer prior to filing claims. If a master list does not exist, then remember to make a comment on the claim form when filing the claim for reimbursement.)