For healthcare providers, few things can be as frustrating as a pending medical claims. Pending
claims can cause a major delay in payment and put a rut in a provider’s revenue cycle. If you
want to increase the fluidity of revenue and prevent delays in medical claims, it’s important to
understand the biggest causes of pending medical claims.
Incomplete or Incorrect Information
The source of a pending medical claim often comes at the very beginning of the process.
Misspellings, incorrect dates, outdated insurance cards, and incorrect ID numbers are all
common reasons for a claim to be denied or delayed. These common mistakes get made early
on, often when intake specialists don’t verify the information. To avoid this, be sure that your
staff is trained to check on frequently incorrect fields, or hire a professional medical claims
examiner to check accuracy for you before sending claims out.
Accurate coding is incredibly important when filing claims. If a code is slightly off or too general,
the claim is almost sure to be denied. Confirm that your staff is up to date on medical coding, or
rely on experienced examiners to check codes and ensure their specificity and accuracy.
Timeliness is almost as important as accuracy when filing medical claims. If you submit a claim
after it’s deadline, it will be denied no matter how perfectly and accurately it has been prepared.
In order to avoid this frustrating cause of delay, make sure that your staff is informed about each
payer’s deadline. If you bring in outside help, you should also be sure to look for a company
that’s experienced and well aware of the importance of timeliness and deadlines when filing
When providers intend to file all of their claims in house, the process can become a little
muddled at times. It takes multiple staff members to take on a large flow of patients and claims.
With so many factors, not to mention the number of things that can go wrong with filing, it’s easy
to see why a lack of communication could lead to incorrect filing, missing information, or late
filing. If you don’t feel strongly about the coordination between your staff members in this area, it
might be best to put the task on medical claim examiners instead of your staff in order to avoid
pending claims and pending payments.
Third Party Payer Requirements
In some cases, third party payers have their own strict policies and guidelines that must be
followed when filing a claim. If these are not met, claims will be delayed and payments will pend
until the claims are corrected to the payer’s standards. This frustrating scenaria is easy to come
across, but not so easy to handle. If you want to avoid the hassle, you can opt for an
experienced claim examiner like Netmark who can help you meet these policies and guidelines
accurately to avoid pending medical claims.