What's the use/purpose of Check Claim in Rev Mgmt
Posted: Thu Mar 03, 2016 7:10 am
Using MS v19, Rev Mgmt, and Relay Health.
I notice that at times I get a claim rejected by the carrier due to a simple error, such as an incorrect zip code, or missing referring provider, or missing date of birth, etc. It may take up to a week after the claim is sent by the clearing house (RH) to the carrier. So, why doesn't the initial Check Claims routine in RM not pick up these rather "administrative" errors before the file is sent out instead of waiting until the carrier processes the defective claim at their end and kicks it back to the sender? Is it a matter of choice re. what types of "checks" to include at this level when RM was originally developed or is there a more systemic or institutional reason (i.e., required by ANSI or CMS, or other) to not check for these errors before they are electronically transmitted to the carrier?
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I notice that at times I get a claim rejected by the carrier due to a simple error, such as an incorrect zip code, or missing referring provider, or missing date of birth, etc. It may take up to a week after the claim is sent by the clearing house (RH) to the carrier. So, why doesn't the initial Check Claims routine in RM not pick up these rather "administrative" errors before the file is sent out instead of waiting until the carrier processes the defective claim at their end and kicks it back to the sender? Is it a matter of choice re. what types of "checks" to include at this level when RM was originally developed or is there a more systemic or institutional reason (i.e., required by ANSI or CMS, or other) to not check for these errors before they are electronically transmitted to the carrier?
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