It pays to question rejections
By Janice Salmon, JustPressOne
Most claims file on the first submission and are placed in a status of either submitted, forwarded or accepted in many of the portals used for claims filing and processing. But what happens when they don’t pass on the first attempt?
You have undoubtedly heard the old cliché “garbage in, garbage out,” which can be used to explain why some claims do not pass the initial rules validation on the first submission. Some of the most common reasons include:
- Data entry errors with the top culprits being model, serial and part numbers
- Invalid or missing part purchase invoice numbers
- Missing picture of the product tag and/or consumer proof of purchase
- Some other piece of required information that’s missing
In addition to errors made by the service provider, the systems used to file claims may not always contain the correct logic. In these situations, you need the attention of the manufacturer or third-party administrator to provide proof that you are right.
How many times have you seen the error message “Invalid Purchase Date” when the entitlement record and the customer’s proof of purchase date is the same date used on the claim? Another example we experienced was a GE claim for an electric dryer, model GTX52EASP0WB, that was rejected for being out of warranty when the unit was serviced in its second year after the purchase. In this case the product carries a five-year manufacturer’s limited warranty. In order to resolve this issue, we had to email GE and request that the claim be overridden for payment.
The bottom line is simply this: Don’t just accept all rejection reasons as valid. Always double check!
There are two levels of validation on home appliance service claims where parts were replaced. First, your data will be validated by the manufacturer’s processing system and must be correct before it can pass to the second level of validation involving a parts distributor. Parts distributors’ turnaround time can vary from two days for Marcone to nearly a week for many others.
The diagram below depicts the process flow for a sample claim that did not pass on the first submission. In this example, which includes the majority of claim types that aren’t approved on the first go around, it can take up to three weeks to get a final status on a claim. This will take even longer if you do not check the status of your claims on a daily basis.
In summary, make sure each claim is checked for errors that you can correct before they are submitted. Also, always check the status of your claims on a regular basis in case a secondary error arises. Finally, if you know for a fact that a rejected claim is correct, such as the example above, contact the manufacturer for resolution.
Don’t leave your hard-earned money on the table!
Janice Salmon is the founder and CEO of JustPressOne, a business process outsourcing company and AVB partner that provides claims administration services for independent appliance servicers and self-servicing dealers. For more information visit JustPressOne.com.
