When is claim resubmission necessary?

Claim resubmission is necessary when there are coding errors because these errors can prevent the claim from being processed accurately or in a timely manner. Coding errors may include incorrect procedure codes, diagnosis codes, or modifiers that do not correspond with the services provided. When a claim is submitted with coding errors, the insurance payer will often deny the claim or request additional information, prompting the need for the claim to be resubmitted with the correct information for proper processing.

The first submission of a claim does not automatically necessitate resubmission unless there are errors or issues causing a denial or delay. It is also not required for every claim submitted, as many claims may be processed correctly the first time. Lastly, resubmission is not contingent solely upon patient request; it primarily arises from the need to correct errors identified during the claims processing phase.