Rejected claims are exceptions, but they should not be handled exceptionally. A repeatable workflow is essential if the practice wants to correct issues quickly and identify the upstream causes creating them.
Create one exception queue
Every rejected or unpaid item should enter a visible queue with a reason, owner, next action and due date. This replaces inbox searching and memory with accountable work.
Learn from the reason codes
Group rejections into useful categories and correct the source of repeated errors.
- Patient and membership information
- Authorisation or referral requirements
- Coding and supporting documentation
- Submission timing or payer-specific rules
- Follow-up and resubmission delays
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