HBI Certified Patient Access Specialist Practice Exam

When a patient's insurance denies a claim, the first step is to gather necessary information and review the denial. This process is crucial because it allows the healthcare provider or billing department to understand the specific reasons behind the denial. It helps in determining whether the denial was due to missing information, coding errors, eligibility issues, or other factors.

By thoroughly reviewing the denial, you can identify the exact nature of the problem which would guide the next steps. For instance, if the denial was due to incorrect coding, the necessary corrections can be made before resubmitting the claim. If it's related to the patient's eligibility, this information can help in addressing the issue with the patient and resolving it appropriately.

Understanding the reasons for denial ensures that the subsequent actions taken, such as appealing the denial or submitting a new claim, are founded on accurate information. This foundational step is essential for effectively managing the claims process and ensuring that the healthcare provider receives payment for services rendered.