The two most common claim submission errors are incorrect patient information and medical coding errors. These mistakes can cause claims to be rejected or denied, delay reimbursement, increase administrative work, and ultimately affect a healthcare practice’s revenue.
When healthcare providers ask, “What are the two most common claim submission errors?”, the answer generally comes down to inaccurate patient or insurance information and incorrect coding. Both issues can often be prevented through careful verification, accurate documentation, proper coding, and a thorough claim review process.
Accurate claim submission is an essential part of medical billing services and Revenue Cycle Management (RCM). When claims are reviewed before submission, practices can improve clean claim rates, reduce avoidable denials, accelerate payments, and maintain healthier cash flow.
At The Medicator’s, we help healthcare providers reduce preventable claim errors through accurate billing, coding, claim review, and revenue cycle management solutions.
The Two Most Common Claim Submission Errors
Healthcare claims can be rejected or denied for numerous reasons. However, two recurring problems are inaccurate patient information and medical coding errors.
Incorrect Patient Information
Incorrect or incomplete patient and insurance information is one of the most common causes of claim rejection. Since patient and payer information is used to identify the individual and determine coverage, even a small discrepancy can prevent a claim from processing correctly.
Common patient information errors include:
- Misspelled or incorrectly entered patient names
- Incorrect date of birth
- Invalid member ID
- Incorrect insurance policy number
- Wrong patient address
- Outdated insurance information
- Incorrect payer information
- Mismatched patient and insurance records
For example, if the member ID entered on a claim does not match the patient’s current insurance record, the payer may reject the claim before it is fully processed.
Verifying patient demographics and insurance eligibility before services are provided can help prevent many of these front-end errors. Practices can also use insurance eligibility verification services to confirm coverage information and identify potential problems before claims are submitted.
Medical Coding Errors
The second major category is medical coding errors. Incorrect, incomplete, or unsupported CPT®, ICD-10-CM, or HCPCS codes can result in claim edits, rejections, denials, incorrect reimbursement, or compliance concerns.
Common medical coding errors include:
- Incorrect diagnosis codes
- Incorrect procedure codes
- Missing or inappropriate modifiers
- Diagnosis and procedure code mismatches
- Upcoding
- Undercoding
- Incorrect use of bundled services
- Missing laterality or required diagnosis specificity
- Coding services that are not supported by documentation
For instance, reporting services separately when payer or coding rules require them to be bundled may result in a denial. Similarly, selecting an ICD-10-CM diagnosis code that lacks the required specificity or laterality can create claim-processing problems.
Accurate medical coding ensures that reported services are supported by the patient’s documentation and align with applicable coding and payer requirements. Regular coding reviews and medical billing audits can also help identify recurring errors before they result in lost revenue or compliance problems.
What Other Errors Can Prevent a Clean Claim?
Although incorrect patient information and coding errors are two of the most common claim submission problems, other issues can also prevent a claim from being accepted or paid.
Healthcare organizations should also monitor for:
- Missing or incorrect provider information
- Invalid National Provider Identifier (NPI)
- Incorrect payer selection
- Missing prior authorization
- Incomplete documentation
- Missing signatures
- Incorrect billing modifiers
- Incomplete claim forms
- Missing supporting records
- Incorrect place-of-service information
These problems highlight why claim review should not focus on coding alone. A complete pre-submission review should evaluate patient information, insurance details, provider information, documentation, coding, and payer-specific requirements.
How Do Claim Submission Errors Affect Healthcare Practices?
Claim submission errors can create problems that extend beyond a single rejected claim. When inaccurate information or coding mistakes become recurring issues, they can negatively affect the entire revenue cycle.
Common consequences include:
- Higher claim rejection and denial rates
- Delayed insurance payments
- Increased accounts receivable
- Additional staff workload
- More time spent correcting and resubmitting claims
- Lost or delayed revenue
- Cash-flow problems
- Greater compliance risk
- Increased exposure to payer audits
A claim that requires correction takes additional time and resources. Billing staff may need to investigate the error, correct the claim, communicate with the payer, and resubmit the information.
This is why preventing errors before submission is generally more efficient than correcting them after rejection or denial.
A strong revenue cycle management process connects eligibility verification, charge entry, coding, claim submission, denial prevention, and payment follow-up instead of treating each activity as a separate task.
How to Prevent Common Claim Submission Errors
Healthcare practices can reduce avoidable claim problems by establishing consistent quality-control procedures before claims are submitted.
Verify Patient and Insurance Information
Confirm patient demographics and insurance details before or at the time of service.
Review:
- Patient name
- Date of birth
- Address
- Insurance company
- Member ID
- Policy number
- Coverage status
- Payer information
Regular eligibility verification can help identify outdated or incorrect insurance information before it reaches the claim.
Review Medical Coding
Coding should accurately represent the services documented in the patient’s medical record.
Before submission, billing teams should verify:
- CPT® codes
- ICD-10-CM codes
- HCPCS codes
- Modifiers
- Diagnosis-to-procedure relationships
- Laterality
- Required specificity
- Documentation support
Coding reviews should also account for payer-specific billing requirements.
Check Documentation Before Submission
Missing or incomplete documentation can create another source of claim problems.
Before submitting a claim, verify that the medical record contains the information needed to support the services and diagnoses being reported.
A pre-submission checklist can identify:
- Missing provider signatures
- Incomplete clinical notes
- Unsupported diagnosis codes
- Missing modifiers
- Missing authorization
- Documentation gaps
- Medical-necessity concerns
This type of review is particularly useful for preventing errors that may otherwise become denials.
Use Claim Scrubbing and Pre-Submission Reviews
Claim scrubbing can identify common data, coding, formatting, and billing issues before a claim reaches the payer.
Automated claim-scrubbing tools can be combined with manual quality checks to catch problems that require human review. A multi-step review process gives billing teams an opportunity to correct errors before submission rather than waiting for a payer rejection.
Submit Complete and Accurate Claims
Every claim should contain the information required by the payer and applicable claim format.
Before submission, review:
- Patient demographics
- Insurance information
- Provider identifiers
- Diagnosis codes
- Procedure codes
- Modifiers
- Documentation
- Authorization requirements
- Payer-specific requirements
Completeness at this stage can significantly reduce avoidable claim rejections.
Conduct Regular Billing and Coding Audits
Regular audits can reveal patterns that are difficult to identify from individual claims.
A billing audit can help practices identify:
- Repeated coding errors
- Documentation problems
- Incorrect claim information
- Recurring denial causes
- Underpayments
- Billing compliance risks
- Process weaknesses
The findings can then be used to improve workflows and provide targeted training to billing and coding staff.
How Can You Catch Missing Documentation Before Submitting a Claim?
One effective way to catch documentation problems is to establish a standardized pre-submission checklist.
Billing teams can confirm that:
- The provider completed the required documentation.
- The documentation supports the reported services.
- Diagnosis codes are supported by the medical record.
- Required signatures are present.
- Modifiers are supported where applicable.
- Prior authorization requirements have been satisfied.
- Any required supporting records are available.
This process helps separate claims that are ready for submission from those that require additional information.
It also allows practices to address documentation issues while the encounter is still relatively recent instead of discovering the problem after a payer denial.
Why Accurate Claim Submission Matters
Accurate claim submission plays an important role in maintaining a healthy medical billing process.
When claims are submitted correctly, healthcare organizations can:
- Improve clean claim rates
- Reduce avoidable denials
- Minimize claim rework
- Accelerate reimbursement
- Improve cash flow
- Reduce administrative costs
- Strengthen billing compliance
- Reduce staff workload
- Improve overall revenue cycle performance
Even small improvements in claim accuracy can have a meaningful effect when applied consistently across hundreds or thousands of claims.
What Role Does Revenue Cycle Management Play in Claim Accuracy?
Claim submission is only one part of the broader revenue cycle. Problems that begin during registration, eligibility verification, documentation, coding, or charge entry can eventually affect claim payment.
A comprehensive Revenue Cycle Management service can connect these stages and help identify errors before they become costly problems.
An effective RCM workflow may include:
- Patient scheduling
- Eligibility verification
- Charge entry
- Medical coding
- Documentation review
- Claim scrubbing
- Claim submission
- Denial management
- Accounts receivable follow-up
- Payment posting
- Reporting and analysis
Addressing errors throughout the revenue cycle is more effective than focusing only on the claim after it has already been rejected.
Why Choose The Medicator’s?
The Medicator’s provides comprehensive medical billing and revenue cycle solutions designed to help healthcare practices improve claim accuracy and protect their revenue.
Our services include medical billing, medical coding, claim review, denial management, payment posting, accounts receivable follow-up, eligibility verification, and billing audits.
Our billing specialists review claims and billing workflows to identify preventable issues, improve coding accuracy, and help practices reduce avoidable denials.
Whether you operate a family practice, specialty clinic, behavioral health organization, urgent care center, or multi-provider medical group, our team provides billing solutions tailored to your practice’s needs.
Through a combination of experienced billing professionals, structured workflows, and technology-supported claim reviews, The Medicator’s helps providers improve the accuracy of their claims and strengthen their overall revenue cycle.
Final Answer: What Are the Two Most Common Claim Submission Errors?
The two most common claim submission errors are incorrect patient information and medical coding errors.
Incorrect names, dates of birth, member IDs, insurance information, and other demographic discrepancies can cause claims to be rejected. Coding problems involving CPT®, ICD-10-CM, HCPCS codes, modifiers, specificity, or documentation can also result in claim edits, denials, or incorrect reimbursement.
The best way to prevent these problems is to verify patient and insurance information, review coding and documentation, use claim-scrubbing processes, and conduct regular billing audits before issues reach the payer.
By focusing on accuracy before submission, healthcare practices can improve clean claim performance, reduce avoidable denials, accelerate reimbursement, and maintain a healthier revenue cycle.
Want to reduce claim submission errors and improve your reimbursement process? Contact The Medicator’s to learn how professional medical billing and revenue cycle management support can help your practice submit cleaner claims and protect its revenue.
