Documentation 101: The Missing Pieces That Often Cause Rejections

Introduction

In the world of insurance, if it isn't documented, it didn't happen. Most rejections aren't about the validity of your health issue; they are about a lack of physical proof.

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The "Big Three" Documents

1. The Itemized Bill

A summary bill (showing just the total) is almost never enough. You need the Itemized Statement which lists every single CPT code, medication, and supply used.

2. The Clinical Narrative

This is a note from your provider explaining the story of your treatment. It bridges the gap between a "code" and a "human need."

3. Evidence of Payment

If you paid out of pocket and are seeking reimbursement, you need the Paid Invoice and a copy of the cancelled check or credit card receipt.

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Organization Tips

• Scan Everything: Keep digital copies in a dedicated folder.
• Reference Numbers: Always write the claim number on the top right of every page you send.
• Timestamping: If you mail documents, use Certified Mail with a Return Receipt.

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Conclusion

Good documentation makes it difficult for an insurer to find a reason to say "No." Treat your claim like a legal case: the more evidence you provide, the higher your chances of success.