Quick Tips - Addressing Returned / Denied Claims

Quick Tips - Addressing Returned / Denied Claims

Here are three common reasons a claim may be denied and some helpful tips to get your claims paid without delay:

  1. Denial Reason: "Duplicate claim":
    • Check other claims to see if the service was paid on another claim;
    • If the service in question was not paid on another claim:
  2. Denial Reason: "Exceeded timely filing":
  3. Denial Reason: "No Prior Authorization on file":

Acceptable reasons for timely filing waivers:

  • Claim submission within 12 months from date of service
  • Claim submission within 12 months from date of denial
  • Claim submission within 12 months from newborn enrollment
  • Claim submission within 12 months from primary carrier’s payments
  • Claim submission within 12 months of third party liability payer exhaust denial (must provide dated denial)

If none of the above reasons apply, a Claim Filing Waiver Form may be submitted with one of the following documents that support attempts of earlier claims submissions:

  • Copy of the electronic claim denial/rejection notification
  • Dated correspondence from UHA with claim information detailing why claim was rejected
  • Dated confirmation of claim receipt

When requesting a waiver, please use the Timely Claim Filing Waiver Form.

If you have any questions regarding timely filing, please contact Customer Services at (808) 532-4000, extension 351, from Oahu or (800) 458-4600, extension 351, from the neighbor islands.

  1. What should you do if you are asked to resubmit a claim with notes?
    1. Submit a paper claim with medical notes attached and write "Resubmission" at the top right hand corner.
  2. What should you do if there is a denial on your claim that you disagree with?
    1. Complete and submit a "Claim Reconsideration Request" form along with your medical notes.
    2. Do not submit a claim with the "Claim Reconsideration Request" form to avoid a duplicate claim denial.
  3. What should you do if you would like to make a correction on a previously submitted claim?
    1. Submit a paper claim and write the words "Corrected Claim" at the top right hand corner.
    2. Please ensure that the corrected claim matches your original claim with the exception of the area(s) that is being corrected.
      See example below:

      Original Claim


      Corrected Claim

      (Line 1: CPT changed to 99213 / Lines 2 & 3 identical to original claim)