How to Increase Your NEMT Clean Claim Rates

Did you know, according to the Experian Health 2024 State of Claims survey, claim denials across healthcare have grown by 31%? 

Approximately 65% of denied claims are never re-submitted, causing providers permanent financial losses. This includes non-emergency medical transportation (NEMT) services that rely heavily on Medicaid reimbursements to fund operations. 

Claim denials substantially impact the business, leading to delayed payments or complete revenue loss for trips. Increasing clean claim rates can save your business time and money and reduce stress.

Wouldn’t it be great to nail all claims on the first go? Adopting efficient practices can cut your number of claim denials. 

This article will help you understand what you can do to ensure clean claim rates. Whether implementing technological integrations, staff training, or strengthening quality control, the guide to successful claim processing is here. 

Understand and Meet Documentation Requirements

To successfully address a claim, it is essential to understand and fulfill the necessary documentation requirements.

Accurate documentation that aligns with payer requirements is more likely to get accepted. 

Imagine you file a claim that is denied due to minute discrepancies in the details, such as incorrect patient information. This avoidable error could create significant headaches. 

NEMT clean claim rates rely on correct documentation. Some common documentation issues that lead to denials are:

• Incomplete trip logs
• Inaccurate GPS attestation
• Incorrect patient details
• Incorrect billing codes
• Lack of supporting documents
• Duplicate or missing signatures
  
  

To ensure claim approval, providers must be careful with their documentation. 

Improve Staff Training

Optimized staff training can significantly reduce errors in claims and lead to successful claim processing. 

Streamlined staff operations are essential for enhanced business performance. A business cannot succeed without adequate employee training.

If you are stuck in the loop of claim filing and denial, here are some things you can do to improve the situation through staff training:

• Workshops on proper documentation practices
• Refresher courses on filling out trip logs
• Clear communication on the impact of errors
• Training sessions for reviewing claim denials
• Implement approaches to prevent mistakes in the future
  
  

Through continuous staff training, you can ensure that your business stays on top of claim management.

Establish a Clear Quality Control Process

Setting up quality control practices is essential for NEMT clean claim processes.  

Did you know by implementing claims quality assurance processes, you can see a 30% reduction in submission errors and a 20% faster claims processing timeline?

As a provider, you want to file claims that can be approved quickly. Establishing quality control processes minimizes claim errors and increases clean claim rates. 

This involves a structured approach to viewing claims before submission, identifying trends in denial, and conducting regular audits to refine and maintain compliance with payer policies. 

Here are the essential aspects of quality control in NEMT claims:

Double Checking Before Submission

Suppose you have a critical claim to file. If this claim gets denied, you will experience substantial revenue loss. 

Double-checking the claim before submission ensures that you don’t make any mistakes in your claims. Missing trip details, incorrect billing codes, or incomplete documentation can cause your claim to be denied. 

Implementing technological help and human oversight as another layer of verification can increase your confidence that your claims will be approved. 

Assigning Staff for Quality Control

Designating specific staff or teams to monitor claims, review denied claims, and track common issues can help you understand your claim status. 

This team analyzes denial trends, educates staff about recurring problems, and recommends process improvements.

Auditing Periodically

Regular audits of submitted and denied claims can uncover inefficiencies and ensure compliance with payer requirements. 

By auditing trip data, driver logs, and policy compliance, you can ensure that all data is accurate and avoid errors. 

Setting up audits at the end of every month reduces the risk of repetitive mistakes.

Leverage Technology to Streamline Billing

Technology can be the backbone for NEMT businesses to optimize the billing processes. 

NEMT software like Tobi streamlines billing by automating data entry, validating claims before submission, ensuring compliance with Medicaid and insurance payer requirements, and reducing human errors. 

Here’s how Tobi, an integrated NEMT software, can help your business mitigate discrepancies in the claim process:

Automated Claims Review

With this feature, you can automate billing from invoice to attestation to submission. 

With Tobi’s automated claims review feature, you can generate detailed invoices for your fleets, streamline the attestation process by validating data automatically, and integrate with billing platforms and brokerages to automate submission.

Real-Time Tracking 

With the real-time tracking feature, you can seamlessly handle invoicing, manage claims, and track reimbursement issues. 

The real-time updates help your business stay on track with claim and payment statuses.

Integrated Compliance

The integrated compliance tools automatically check claims for compliance with Medicaid rules and payer-specific guidelines. 

This includes validating trip purposes, driver credentials, and trip eligibility criteria.

Rethinking Your Claims Process

NEMT clean claim rates are essential for improving cash flow, reducing administrative burdens, and building strong relationships with payers. 

Focusing on long-term integrations can ensure that your business minimizes claim denials and enhances financial stability. 

What steps can you take today to make clean claims the norm for your business?

NEMT software integrations like Tobi improve operations and reduce human error. This strengthens the process and allows you to focus on what matters. 

With Tobi, you don’t have to worry about your claims. With features automating every step, your claims process becomes much more streamlined and efficient. 

Are you ready to embrace the future of clean claim rates? Let Tobi help you.

Request a demo for a free 30-day trial and experience how Tobi makes your business better at every turn.