When you get the denial Claims lack information or need additional information then follow the below steps to resolve the issue:
1) Check the EOB and find out what type of information required and from whom (Patient or provider) by seeing RARC (Remittance advice remark code) in order to reimburse the claim or reach our claims department if the information is not clear.
If the Information required from Patient :
a) Check when insurance have sent the letter to patient requesting the missing or lacking information.
b) If it is more than 30 days check to see if patient has updated the requested information with insurance.
c) If patient has already updated, then send the claim back for reprocessing.
d) If not update, then request insurance to send one more letter to patient to update the missing information.
If the information required from provider:
a) If you found the exact information that what insurance need from provider, then resubmit the claim with missing or lacking information for reimbursement.
Note: RARC place a major role in finding out the exact information required from the insurance company
Follow this Procedure when you call insurance Company and ask Questions to get the Appropriate information.
| Claim denied for Lack of information which is needed for adjudication – Denial Code CO 16 | ||
| 1 | May I know the Claim received date | |
| 2 | May I know the claim was denied | |
| 3 | May I know what information is required to process the claim | |
| 4 | May I know from whom the required information is needed whether patient/provider | |
| 5 | May I know whether any letter sent to patient/Provider | |
| 6 | If Yes | If No |
| 7 | May I know when the letter was sent to patient/provider | Could you please send a letter to patient/Provider |
| 8 | Is there any response from the patient/provider | |
| 9 | If Yes | If No |
| 10 | Could you please send the claim back for reprocess | Could you please send one more letter to patient/Provider( as per Client specific) |
| 11 | May I know the claim# | |
| 12 | May I know the call ref# |
