When submitting an insurance claim, the healthcare provider's billing department must ensure accurate and compliant claim filing. What is the BEST step to take before claim submission to ensure it meets the payer’s requirements and reduces the likelihood of claim denials?
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Submit the claim with basic patient information and amend it later
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Verify patient insurance eligibility and benefits
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Forward the claim to a secondary payer immediately
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Assign random diagnostic codes if unsure about the specifics
Before submitting an insurance claim, it is crucial to verify patient insurance eligibility and benefits. This directly affects claim approval because if a patient is not eligible for the services billed, the claim will be denied. Verifying insurance includes confirming the patient’s coverage on the date of service, deductible amounts, co-insurance, and copay responsibilities, as well as any exclusions or limitations in their policy. This step reduces the risk of denials for issues such as non-covered services or inactive insurance and contributes to a smoother revenue cycle process.
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