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  3. Medical: Pharmaceuticals

claim level denial

Russian translation: отказ в страховом возмещении по обращению в целом

17:57 Feb 20, 2024
English to Russian translations [PRO]
Medical - Medical: Pharmaceuticals
English term or phrase: claim level denial
HMSA received your appeal from Ms. Lora Green of the State of Hawaii Med QUEST Division on January 30, 2024, about the claim level denial.
Per our conference call on February 12, 2024, with the assistance of a Russian language interpreter, it was determined that the services you received from Dr. Lowry was paid in full.
As discussed, the claim level denial you appealed was processed correctly and you are not responsible for any charges that were denied.
Anastasia Serdyukova
Russian Federation
Local time: 01:14
Russian translation:отказ в страховом возмещении по обращению в целом
Explanation:
Denial of the entire claim is considered a claim-level denial. For many hospitals, this type of problem accounts for the majority of Medicare and Medicaid denials and typically results from inaccuracies related to patient registration, late-charge management, duplicate billing, production of medical information for external review, and/or physicians’ ordering practices. Common denial types include the following:

> The patient was not identified as insured
> The claim submitted was a duplicate
> The services were deemed by the payer as not medically necessary
> The charges for outpatient services were in proximity to inpatient services
> The patient’s date of death preceded the date of service
Selected response from:

Alexander Elizarov
Kazakhstan
Local time: 03:14
Grading comment
4 KudoZ points were awarded for this answer



Summary of answers provided
3 +1отказ в страховом возмещении по обращению в целом
Alexander Elizarov


  

Answers


1 hr   confidence: Answerer confidence 3/5Answerer confidence 3/5 peer agreement (net): +1
отказ в страховом возмещении по обращению в целом


Explanation:
Denial of the entire claim is considered a claim-level denial. For many hospitals, this type of problem accounts for the majority of Medicare and Medicaid denials and typically results from inaccuracies related to patient registration, late-charge management, duplicate billing, production of medical information for external review, and/or physicians’ ordering practices. Common denial types include the following:

> The patient was not identified as insured
> The claim submitted was a duplicate
> The services were deemed by the payer as not medically necessary
> The charges for outpatient services were in proximity to inpatient services
> The patient’s date of death preceded the date of service


    Reference: http://www.insuranceclaimdenialappeal.com/2010/07/dispute-in...
Alexander Elizarov
Kazakhstan
Local time: 03:14
Native speaker of: Native in RussianRussian
PRO pts in category: 4

Peer comments on this answer (and responses from the answerer)
agree  Erzsébet Czopyk
3 days 4 hrs
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