5/11/2022
Midlands Choice recently implemented a process that will reduce the amount of paper claim rejections that are mailed to providers. In the past, whenever a claim was rejected at Midlands Choice the claim face sheet showing the rejection and a representation of the claim was printed and mailed to the provider billing address submitted on the claim. Working with EDI clearinghouses, the majority of claims that are rejected are now returned electronically at the clearinghouse level.
A claim can be rejected by Midlands Choice due to various reasons, including a missing or unidentifiable group number on the claim, a group that is no longer with Midlands Choice, a claim that is sent to Midlands Choice in error, missing information on the claim such as the patient’s date of birth, or a claim submitted on an incorrect form. When any of these occur, the claim is shown as rejected and a rejection reason is displayed on the EDI clearinghouse report.
This new initiative impacts all claims that are submitted to Midlands Choice through an EDI clearinghouse. Claims that are mailed to Midlands Choice and are rejected will still be printed and mailed to the provider billing address.