Learn how using best billing practices can make all the difference for your home care agency!
Finding and Fixing Denied Claims: The 6-Step Process
Denied or partially paid claims don’t have to end dead. GEOH recommends a clear, repeatable six-step approach using GAMMIS.
Step 1: Find Denied or Partially Paid Claims
Run claim searches or review Remittance Advice (RA) reports to identify denials or underpayments.
Step 2: Identify the Denial Reason
Review EOB codes and descriptions in GAMMIS or on the RA to understand why the claim failed.
Step 3: Locate the Specific Claim
Use the claim ID (ICN) or member details in GAMMIS to pull up the exact claim that needs correction.
Step 4: Open Claim Details
Verify all submitted information and confirm you’re reviewing the correct submission, especially if the claim was billed more than once.
Step 5: Make the Correction
Adjust the claim based on the denial reason. This may include:
- Adding or correcting modifiers
- Fixing procedure codes
- Adjusting units or service dates
Step 6: Submit the Adjustment
Click “Adjust” to resubmit the corrected claim. Monitor the next processing cycle and confirm payment on the following RA.
Why RA (Remittance Advice) Reports Matter for Billing
Your RA report is one of the most important billing tools you have, and often the most overlooked.
What RAs Tell You
- Which claims were paid, denied, or adjusted
- Any takebacks or recoupments from previously paid claims
- Adjustments related to audits or corrections
Important: The RA is the only notification you receive for claim adjustments. If you don’t review it weekly, you could miss repayments owed or opportunities to rebill.
Best practice: Compare your RA every week against internal records so issues are caught early, before timely filing deadlines pass.
Best Billing Practices to Prevent Denials
Prevention is always easier than correction. These habits can dramatically reduce denials:
1. Verify Data Before Releasing Claims
Double-check visit data (times, codes, GPS, units) in your EVV system before billing. Fix issues like missed clock-outs immediately.
2. Keep EVV and Authorizations in Sync
Ensure procedure codes and modifiers in your system exactly match the authorization. A single setup error can cause repeated denials.
3. Monitor Authorization Utilization
Regularly check remaining units in GAMMIS. If a client is nearing their limit, request additional units before services become non-billable.
4. Review Remittance Advice Weekly
Act quickly on denials using the 6-step process. Prompt follow-up often turns a denial into a payment.
5. Use GAMMIS as Your Source of Truth
EVV systems may flag an error, but GAMMIS explains why. Use claim, PA, and RA inquiries often to troubleshoot issues accurately.
Need Help? You’re Not Alone
If a denial reason doesn’t make sense or you’re unsure how to fix it, don’t guess. GEOH’s team is here to help, just click here to reach support.
With the right tools and consistent best billing practices, denied claims don’t have to slow you down. They can become opportunities to strengthen your billing workflow and get paid faster.
