Every rejection is handled twice
Assessment costs are incurred on the first submission and again on the resubmission, for a claim that was always going to be paid.
WHY AN INSURER WOULD WANT THIS
Rejections are the most expensive way to enforce a rule.
An insurer rejecting an incomplete claim is not winning anything. They have paid to receive it, paid to assess it, paid to reject it, and will pay again when it is resubmitted.
Disputes are mostly not disputes
The bulk of the queue is completeness, not coverage. Real coverage questions get the same attention as a missing signature.
Provider relationships erode
A clinic that waits six weeks for money it is owed treats the insurer as an obstacle, and that shows up in how the insurer's members are treated.
Rule changes cannot be rolled out
An insurer that updates a code pairing has no way to reach the front desk. The only channel is the rejection, which is the slowest and most expensive one available.
Checking completeness before submission is cheaper for the insurer than after, and it is the same check either way.
If you submit claims, or assess them.
The useful thing is your actual rejection reasons and how long a round trip takes.
maya.anggraini@berkasawal.online
Denpasar, Bali