10 reasons cashless claims are denied or cut, seen from the hospital side

When a cashless claim is denied or paid short, the patient blames the hospital and the hospital waits longer for its money. These are the reasons we see most, and the check that prevents each one.

The ten reasons

• Waiting period or exclusion: the condition is not covered yet. Check the policy terms at pre-auth, not at discharge.
• Non-disclosure of an earlier illness. The doctor's notes should record history accurately, as it is.
• Treatment that did not need admission. Record clearly why the patient needed to be in hospital.
• Missing investigation reports for tests charged in the bill.
• Room category higher than the policy allows, which cuts every linked charge in proportion.
• Name, age or gender mismatches across documents.
• Dates that do not line up between the discharge summary, the nursing chart and the bill.
• Missing signatures, stamps or doctor registration numbers.
• Non-payable consumables billed as separate items.
• Late submission of the final file after discharge.

What the desk can do

Nearly every item on this list can be found by reading the file carefully before it is sent. The difficulty is doing that for every file, every day, with a hundred pages each.

A second pair of eyes for every file

Ekline Claims reads every page of the scanned file against your hospital checklist and each payer's document list, and returns the gaps desk by desk, with the page number, before the file leaves the hospital.