Which is a common reason for claims rejection?

Claims rejections in pharmacy billing often result from incorrect patient information, such as an erroneous date of birth or a wrong insurance policy number. This is critical because health insurance claims require precise and accurate patient identification to ensure that the services billed are correctly matched with the right patient. If any discrepancies are found in the information provided, such as a mismatch between the patient’s demographic details and what the insurance company has on file, the claim is likely to be rejected.

Accuracy in patient personal details helps facilitate the smooth processing and reimbursement of claims, which is why this factor is a common cause for rejection. While incorrect billing codes, missing prescription details, and outdated drug formularies can also lead to issues, the accuracy of patient information is fundamental to ensuring that claims are not rejected at the outset.