When claims are denied, resubmission is often the only path to recovering revenue. But simply “resending” the same claim won’t solve the problem. Efficient claim resubmission requires a strategic, error-free, and timely process. This blog outlines the best practices to improve your claim resubmission success rate—and get paid faster.
1. Understand the Reason for Denial
Brief Explanation:
Before resubmitting, you must know why the claim was denied.
Best Practice:
Review the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) to understand denial codes. Categorize them (e.g., eligibility, coding, authorization) for easier processing.
Why It Works:
Avoids repeating the same mistake and increases chances of approval.
2. Correct the Original Claim
Brief Explanation:
Resubmitting without correcting the root issue wastes time and risks another rejection.
Best Practice:
Make necessary corrections—such as fixing CPT codes, updating insurance details, or attaching missing documentation—before resubmitting.
Why It Works:
Clean, corrected claims improve first-pass resolution rates after denial.
3. Include Supporting Documentation
Brief Explanation:
Some claims are denied due to missing or unclear medical necessity.
Best Practice:
Attach proper medical records, operative notes, lab results, or referrals as proof when needed.
Why It Works:
Payers are more likely to approve claims when documentation clearly supports the services billed.
4. Submit Within Timely Filing Limits
Brief Explanation:
Every payer has a deadline for resubmission after a denial.
Best Practice:
Track payer-specific timelines (usually 30–90 days from the denial) and prioritize urgent cases in your billing system.
Why It Works:
Avoids payment loss due to missed deadlines.
5. Use Correct Claim Type (Corrected vs. Resubmitted)
Brief Explanation:
Payers often distinguish between a corrected claim and a resubmission.
Best Practice:
Mark the resubmission correctly on the claim form:
- Use appropriate resubmission codes (e.g., Frequency Code 7 for corrected claims).
- Reference original claim numbers.
Why It Works:
Prevents confusion or rejection for duplicate submissions.
6. Automate and Track Resubmissions
Brief Explanation:
Manual tracking of resubmissions can lead to missed opportunities and delays.
Best Practice:
Use billing software with claim status tracking, resubmission alerts, and denial dashboards.
Why It Works:
Keeps your team organized and ensures no claim falls through the cracks.
7. Follow Up with Payers
Brief Explanation:
Even after resubmitting, it’s essential to ensure your claim is processed.
Best Practice:
Follow up after 7–10 days to check the status. If unresolved, escalate to payer reps or appeals.
Why It Works:
Proactive follow-up reduces cycle time and improves payment recovery.
Conclusion
Claim resubmission is more than re-sending a denied claim—it’s a precision-driven correction process. By following structured best practices and using the right tools, healthcare providers can significantly boost their claim approval rate and shorten revenue delays. At Bright Health Alliance, our expert denial management team handles the entire resubmission process with care—so you get paid faster, with fewer headaches.
