Conquering a VA Claim

September 16, 2020

Diamond Sinegal

“I have found that working VA claims can be very challenging. I was recently working a VA claim for one of my offices that the office had received prior authorization prior to the completion of treatment. Prior to bringing on eAssist the office submitted the claim and included a copy of the prior authorization. Shortly after taking on the office we received a rejection letter stating that the patient account number was missing. I reviewed the information previously submitted which included the patient’s social, member ID number and a copy of the pre authorization.

I contacted the VA rep the office had listed and he asked if the patient’s chart number assigned by the office had been inputted on the claim form. I found that it had not been and resubmitted all information electronically and by mail. This time I ensured the patient’s chart number was included. I called to follow up on the claim about a week later. This time I located the number for the VA processing center that sent the denial and I contacted them directly. The representative that I spoke with there stated that the claim was received; however it was still being denied due to the patient account number not being included on the claim form. I explained that the claim had been resubmitted to include the patient’s chart number. I then asked this representative for clarification on what was considered the patient’s chart number that was missing. He stated that it was the pre authorization number. I explained that this had been included as an attachment to the claim mailed in. It was stapled to the claim form. He informed me that the pre authorization number must be included on the actual claim form.

I updated the claim form to include the pre authorization number and resubmitted the claim electronically and by mail. The claim was processed and paid that same week! The moral of the story is to not give up! As frustrating as it may be at times you have to keep pushing and working those claims!”