Avoiding Claim Submission Errors: Common Pitfalls and How to Prevent Them

Claim submission is a vital step in the revenue cycle for any healthcare practice or billing team. A single error in this process can lead to costly delays, claim denials, or outright rejections—each one affecting cash flow and administrative efficiency. Whether you're a seasoned biller or new to the field, understanding the most common claim submission errors is crucial to ensuring claims are processed smoothly and paid promptly.

Let’s dive into some of the most frequent errors encountered during claim submission and how to avoid them.

1. Duplicate Claims: A Costly Mistake

What it is:

A duplicate claim occurs when the same claim is submitted more than once for the same date of service, provider, and patient, without justification.

Why it happens:

• Miscommunication within the billing team

• Delays in claim status updates from the payer

• Automated billing systems sending multiple batches

  
  

Impact:

Duplicate claims are one of the leading causes of denials. Insurance payers see them as redundant and may flag them as billing abuse if done repeatedly. These denials waste time and can trigger audits or raise compliance concerns.

How to avoid it:

• Implement a reliable claim tracking system

• Establish a clear communication protocol within your billing department

• Always verify the claim status before resubmitting

  
  

2. Incomplete or Inaccurate Patient Information

What it is:

Claims with missing or incorrect patient demographics—such as name, date of birth, insurance ID, or policyholder details—are often rejected at the clearinghouse or by the payer.

Why it happens:

• Typos during data entry

• Relying on outdated patient information

• Incorrect coordination of benefits (COB)

  
  

Impact:

Claims are rejected before they even reach adjudication, which delays payment and increases administrative workload. It also frustrates patients when they receive unexpected bills or denial notices.

How to avoid it:

• Verify all patient information at every visit—even returning patients

• Use insurance eligibility verification tools before submitting claims

• Train front desk and billing staff to double-check all fields

  
  

3. Incorrect Provider Information

What it is:

This includes submitting claims with wrong or mismatched provider data, such as the National Provider Identifier (NPI), Tax Identification Number (TIN), or address.

Why it happens:

• Provider credentialing changes not updated in the system

• Multiple locations or providers under the same group not properly identified

• Typographical errors in the claim form

  
  

Impact:

Incorrect provider information often leads to rejections, especially when the data doesn’t match what the payer has on file. This can delay payment and may require re-credentialing efforts if the issue persists.

How to avoid it:

• Maintain up-to-date provider rosters and credentialing data

• Periodically audit claim submissions for accuracy

• Ensure your billing software is configured with correct NPI/TIN combinations for each provider and location

  
  

4. Untimely Filing: Missing the Deadline

What it is:

Every insurance payer has a specific time frame within which a claim must be submitted after the date of service. Submitting claims outside of this period results in automatic denials.

Why it happens:

• Delays in documentation from the provider

• Inefficient billing workflow

• Claims sitting in “draft” or “on hold” status without follow-up

  
  

Impact:

Untimely filing can lead to a complete loss of reimbursement. Most insurance companies do not allow appeals for late submissions unless there are extenuating circumstances—leaving the provider responsible for the cost.

How to avoid it:

• Know the timely filing limits for each payer (e.g., Medicare: 1 year; some private insurers: 90-180 days)

• Create internal reminders and workflows to prioritize older claims

• Monitor aged claims reports regularly to catch issues early

  
  

5. Medical Necessity Issues

What it is:

Claims may be denied if the payer determines that the service was not medically necessary or was not adequately documented.

Why it happens:

• Lack of detailed clinical documentation

• Services not matching the patient’s diagnosis codes

• Billing for non-covered services under a patient’s specific plan

  
  

A) Lack of Documentation

When medical records don’t clearly justify why a procedure, test, or service was performed, the insurance company may deny the claim for failing to demonstrate medical necessity. Payers require clear connections between the diagnosis and the treatment provided.

B) Non-Covered Services

Even medically necessary procedures may be denied if they are not included in the patient’s benefits. Each insurance plan has different limitations, and what’s covered under one may be excluded in another.

Impact:

Denials based on medical necessity can result in significant delays, appeals, or even patient responsibility for high-cost services. Repeated denials can also damage payer-provider relationships.

How to avoid it:

• Ensure documentation supports the necessity of services rendered

• Link appropriate and specific diagnosis codes to every procedure

• Use benefit verification tools before providing elective or high-cost services

• Educate clinical staff on documentation requirements and payer-specific policies

  
  

Final Thoughts

Claim submission errors can drain time, money, and resources from healthcare practices. Fortunately, most of these mistakes are preventable with the right processes, training, and technology in place.

By focusing on clean claims—those submitted correctly the first time—you can boost your revenue cycle performance and reduce administrative overhead. Review your current workflows and make the necessary adjustments to avoid these common pitfalls.

A few proactive steps to remember:

• Keep patient and provider records current

• Cross-train staff for better accuracy

• Utilize claim scrubbers and eligibility tools

• Audit claims regularly before submission

• Ensure documentation supports the services billed

  
  

A little extra diligence upfront can save your team from big headaches later. Stay sharp, stay informed—and your claims will be far less likely to come back denied.me back denied.