Common Medical Billing Rejections: Taylor Prime Solutions Has the Solutions You Need

Medical billing is the lifeblood of any healthcare practice, but navigating the complexities of claim submissions can often feel overwhelming. One of the most common challenges providers face is medical billing rejections. At Taylor Prime Solutions, we specialize in tackling these challenges head-on, offering tailored solutions to ensure your claims are processed smoothly and efficiently.

Lets explore the six most common medical billing rejection codes across different categories—practice-related, provider-related, patient-related, insurance-related, encounter-related, and payment-related. For each rejection type, we’ll provide actionable checklists to fix the issue and resubmit a corrected claim.

1. Practice-Related Rejection: Missing or Invalid Place of Service Code

Rejection Code: CO-5
This occurs when the Place of Service (POS) code submitted on the claim does not align with the services provided or is missing altogether.

Checklist to Fix CO-5:

Verify POS Code: Check the POS code submitted against the service location guidelines provided by the payer.
Review Documentation: Confirm that the documentation matches the POS code.
Correct the POS Code: Update the claim with the appropriate POS code.
Submit Corrected Claim: Resubmit the corrected claim with all required documentation.

Taylor Prime Solutions, ensure that every claim is meticulously reviewed for accuracy before submission, minimizing the risk of practice-related rejections like CO-5.

2. Provider-Related Rejection: Invalid or Missing Provider Identification Number

Rejection Code: CO-16
This happens when the National Provider Identifier (NPI) or Tax Identification Number (TIN) is incorrect or missing.

Checklist to Fix CO-16:

Validate Provider Information: Confirm the accuracy of the NPI and TIN in your billing software.
Update Records: Correct the provider’s information in your system.
Contact the Payer: Ensure the provider is properly enrolled with the payer.
Resubmit Claim: Submit a corrected claim with the updated provider details.

With our expertise, Taylor Prime Solutions ensures provider enrollment and credentialing are always up-to-date to prevent these errors.

3. Patient-Related Rejection: Incorrect Patient Information

Rejection Code: CO-31
This occurs when patient demographic details, such as name, date of birth, or insurance ID, are incorrect or do not match the payer’s records.

Checklist to Fix CO-31:

Verify Patient Information: Cross-check the patient’s details with the insurance card and medical records.
Correct Errors: Update the claim with accurate patient demographics.
Double-Check Records: Ensure the corrected information aligns with the payer’s database.
Submit Corrected Claim: Resubmit the claim promptly.

Taylor Prime Solutions utilizes advanced verification processes to catch errors before claims are submitted, saving you time and money.

4. Insurance-Related Rejection: Non-Covered Services

Rejection Code: CO-96
Claims are rejected if the service provided is not covered under the patient’s insurance plan.

Checklist to Fix CO-96:

Check Insurance Coverage: Verify if the service is covered under the patient’s plan.
Obtain Prior Authorization: If applicable, secure prior authorization for the service.
Provide Additional Documentation: Submit supporting documents to justify the service.
Appeal if Necessary: If the service should be covered, file an appeal with the payer.

At Taylor Prime Solutions, we streamline insurance verification and prior authorization to mitigate rejections like CO-96.

5. Encounter-Related Rejection: Duplicate Claim Submission

Rejection Code: CO-18
This occurs when the same claim is submitted multiple times for the same encounter without proper justification.

Checklist to Fix CO-18:

Review Submission Records: Verify whether the claim was already processed.
Check Claim Status: Use payer portals to confirm if the original claim was denied or paid.
Resolve Duplicate Entries: Ensure duplicate claims are voided in your system.
Resubmit Corrected Claim: Submit only necessary claims with proper adjustments.

Our robust claim tracking system at Taylor Prime Solutions helps prevent duplicate submissions and keeps your billing organized.

6. Payment-Related Rejection: Timely Filing Limit Exceeded

Rejection Code: CO-29
Claims rejected under this code were submitted after the payer’s allowable time frame for filing.

Checklist to Fix CO-29:

Review Filing Deadlines: Confirm the payer’s timely filing limits.
Submit Appeal: If there are extenuating circumstances, file an appeal with documentation explaining the delay.
Track Deadlines: Implement reminders to track claim filing deadlines.
Update Workflow: Streamline claim submission processes to avoid future delays.

Taylor Prime Solutions leverages automated reminders and efficient workflows to ensure claims are submitted well within the payer’s deadlines.

How Taylor Prime Solutions Eliminates Common Medical Billing Rejections

Handling medical billing rejections requires more than just a quick fix—it demands a proactive approach and in-depth expertise. At Taylor Prime Solutions, we take the burden off your shoulders by:

Conducting thorough pre-claim reviews to catch errors before submission.
Implementing advanced technology to streamline insurance verification, credentialing, and claim tracking.
Providing ongoing staff training to ensure compliance with payer guidelines and industry regulations.
Monitoring claims to detect and resolve rejections quickly.

Our solutions are designed to save your practice time, reduce denials, and maximize revenue.

Take Action Today

Don’t let common medical billing rejections slow down your revenue cycle. Partner with Taylor Prime Solutions for expert support and innovative solutions to keep your claims moving forward.

Ready to optimize your billing process and reduce rejections?

Contact us today and experience the Taylor Prime Solutions difference!

For more information regarding Common Medical Billing Rejections, check out the website for Maryland Department of Health Provider Services