Claims- Common Rejections

Filing insurance claims can feel overwhelming, especially if you're new to the process! To help make things smoother, it's a good idea to take a moment to review some of the most common reasons claims get rejected and the key details to check before submitting. Often, a claim can be denied simply because a small but critical piece of information was overlooked. By familiarizing yourself with the specific codes and requirements your payer uses, you’ll gain confidence and streamline the process over time. A little preparation upfront can save you a lot of time and hassle later!

Box 2: Patient's Name

Ensuring that the name on the ID matches the name of the insured. Some times clients may have changed their name, and not have updated their name with their insurance company. When you are filing a claim, make sure you are filing with the same name that appears on their insurance ID card.

Box 21: Diagnoses Codes

When you are filing your insurance claim, using the correct diagnosis code for your payer. You may have been provided a provider manual with that payers' specific codes, or can find that information in a web search!

Box 24 B: Place of Service Codes

Ensure that you select the correct place of service code that corresponds to where the service was rendered as well as an modifiers your payer requires.

• 02-Telehealth
  • some payers require modifiers for this service code
• 03-School
• 11-Office
• 12-Patients Home
• 13-Assisted Living Facility
• 14-Group Home
• 15-Mobile Unit
• 16-Temporary Lodging
• 18-Place of Employment/Worksite
• 21-Inpatient Hospital
  • if you select this code you need to add the admit date in box 18
• 22-Outpatient Hospital
• 25-Birth Center
• 49-Independant Clinic
• 99-Other

Box 24D: Procedure Codes & Modifiers

When billing for doula services, "Box 24D" on a medical claim form refers to the section where you would enter the primary procedure code for your services. Depending on the specific service provided, you may also need to include relevant modifiers to accurately describe the support given, like "HD" for "home delivery" or other modifiers based on your individual payer or state regulations. Always verify the current billing codes and modifiers required for doula services in your specific region. After the CPT Code, you can enter up to 4 modifiers per line.

Box 24 J

You may have an individual NPI, a group/business NPI or both. The information entered in this box depends on how you are "credentialed" (registered) with the payer you are submitting to. If you are credentialed using your company, then you would use the company name and the organizational NPI. If you are credentialed as an individual, you can put your own name and personal NPI in box 33.

For example, you may have an NPI under your personal name as well as one for your LLC. When you credential with a payer, you will provide one of those numbers to setup with them. Regardless, the rendering provider in Box 24J is always a person (individual NPI).

Box 33: Billing Provider Info

Ensuring all of your information for your business or group is correct and present in this field.