Submission Not Compliant with Contractual Agreement Between Provider and Payer
As a healthcare provider, it is essential to understand and comply with the contractual agreement between you and your payer. Failure to do so can result in delayed payments and even legal consequences. One common issue that providers face is submitting claims that are not compliant with the contractual agreement with the payer.
There are several reasons why a claim may not be compliant with the contractual agreement between the provider and the payer. These reasons may include utilizing incorrect codes, coding for services not covered under the contract, or failing to adhere to the payer`s billing guidelines. Whatever the reason, it is essential to address and correct the issue as soon as possible to avoid further complications.
One of the most effective ways to avoid submitting non-compliant claims is to review and understand the contractual agreement between the provider and the payer thoroughly. This agreement typically outlines the services covered under the contract, billing requirements, and payment rates. By understanding these parameters, providers can ensure that they bill appropriately and within the agreement`s guidelines.
Another critical step in avoiding non-compliant claims is to stay up to date with coding and billing changes. Healthcare providers should regularly review and update their coding practices to ensure that they are using the most recent, accurate codes for services provided. They should also stay informed of any changes to billing guidelines or payment rates outlined in the contractual agreement.
Finally, it is essential to double-check all claims before submission to ensure that they are compliant with the contractual agreement. This includes verifying that all services provided are covered under the contract, that codes used are accurate, and that billing guidelines are followed. By doing so, providers can avoid the hassle of denied claims and payment delays.
In conclusion, submitting claims that are not compliant with the contractual agreement between the provider and the payer can lead to significant complications. Providers should take the necessary steps to ensure that they understand the agreement, stay up to date with coding and billing changes, and double-check all claims before submission. By doing so, they can avoid the headache of non-payment and focus on providing quality healthcare services to their patients.