A claim is denied due to termination of coverage. Which action should the billing and coding specialist take next?

A claim is denied due to termination of coverage. Which action should the billing and coding specialist take next?

• A. Submit the claim again immediately
• B. Contact the patient to confirm current name, address, and insurance carrier for resubmission
• C. Wait for 30 days before re-submitting
• D. Notify the payer of address change

Answer: (B)

When a claim is denied because coverage has terminated, the next step is to verify the patient’s current insurance information before resubmitting. Contacting the patient to confirm the current name, address, and insurance carrier helps ensure the claim is submitted to the correct payer and with active coverage. If the patient no longer has that policy, you’ll need to know whether there is a new plan or updated policy details to bill correctly, or determine the patient’s responsibility. Resubmitting with outdated or wrong information will likely result in another denial or delayed payment, so confirming details first is essential. Submitting the claim again immediately without updating information is unlikely to succeed. Waiting 30 days isn’t a standard approach for this situation, and simply notifying the payer of an address change doesn’t address the denial reason or current coverage status.

When a claim is denied because coverage has terminated, the next step is to verify the patient’s current insurance information before resubmitting. Contacting the patient to confirm the current name, address, and insurance carrier helps ensure the claim is submitted to the correct payer and with active coverage. If the patient no longer has that policy, you’ll need to know whether there is a new plan or updated policy details to bill correctly, or determine the patient’s responsibility. Resubmitting with outdated or wrong information will likely result in another denial or delayed payment, so confirming details first is essential.

Submitting the claim again immediately without updating information is unlikely to succeed. Waiting 30 days isn’t a standard approach for this situation, and simply notifying the payer of an address change doesn’t address the denial reason or current coverage status.