What information is crucial to include in a claim submission to prevent denial?

The inclusion of correct provider information and service codes in a claim submission is essential to prevent denial. Accurate provider information ensures that the insurance company can identify the physician who performed the services, confirming their credentials and eligibility to bill for those services. Service codes, such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes, are critical as they detail the exact services rendered and the medical necessity of those services.

If either the provider information or the service codes are incorrect or unclear, the claim could be denied due to ineligibility, lack of authorization, or because the insurer is unable to match the services rendered to the patient's coverage plan. This highlights the importance of attention to detail when submitting claims, as any discrepancies can lead to delays in processing or outright denial of claims, impacting the revenue cycle of the healthcare provider.

The other options, while providing helpful context about the patient's care, do not have the same direct impact on the processing and approval of a claim. For instance, a patient's medical history or a list of medications, though relevant to clinical decisions, is not typically required for billing purposes. The provider's personal information is generally not necessary in the claim submission, as the focus should be on their