We’ve all been there: you log on to your computer to start the day, only to find that dreaded email regarding your last batch of claims. Claim denied. This is a frustrating situation for any biller to find themself in, but luckily, there’s ways to reduce the amount of denials you receive. It all starts with understanding why claims are denied in the first place. Claim denials are sent for a variety of reasons, but in a nutshell, it’s because the payer does not believe the service can be paid for through insurance based on the data sent over. We took a look at a few of the top reasons claims are denied to give you a better understanding of the situation. 

Why was your claim denied?

There’s no “one size fits all” answers to claim denials, but there are a few common reasons claims end up getting denied. When you receive a denied claim, don’t panic. There’s usually potential to fix the error and resubmit the claim. Knowing what to look for, and how to address a specific denial, will help you respond productively to the denied claim. These are some of the top reasons billers receive medical billing denials:

Missing information

Claims with blank fields are a common trigger for denials. Whether you forgot to ask for some important patient information, or a box was accidentally left blank, missing information is going to leave you with a denied claim. 

Duplicate claim

This one may sound like a tough mistake to make, but all it takes is one wrong click to send a duplicate claim. Duplicate claims are ones that were sent on the same date, for the same patient, with the same information.

Service already adjudicated

This error comes up when payment for the listed service has already been adjudicated on another claim. 

Service not covered by insurance

If a patient’s insurance provider doesn’t cover the listed service, the claim will be denied. This can be avoided by verifying insurance coverage before the appointment, and if need be, contacting the insurance company to inquire about a specific service. 

Limit for filing expired

Medical claims typically have to be filed within a set number of days. This includes the time it may take to fix a rejected claim. Since there can be a lot of different moving parts in the billing process, it’s important to make sure that everyone is on the page regarding deadlines and is able to fulfill their responsibility to avoid late filing. If a claim is denied and needs to be reworked, an extension on the deadline may be granted. 

How to prevent medical claim denials

While it may be easier said than done, it’s absolutely possible to reduce the number of claim denials you receive. With a dedicated, cohesive team and a plan of action for getting claims submitted without error the first time, you’ll find yourself reducing or even eliminating denied claims. Here are some tips on what to do to prevent medical claim denials:

Gather more data up front

Many claim denials occur because of missing or incorrect information. When it comes to patient data, this is completely preventable with a little extra attention to detail. Create a list of questions for your staff, highlighting must-have answers and ensure they gather this information before the appointment. This is a simple yet effective way to prevent denials from showing up. 

Track denial data

If you don’t know why your claims are getting denied, you can’t prevent the problem. Using your reporting tools, track where your denials are coming from, narrowing down the highest percentage of reasons for denials, so you can address the issues and reduce denied claims. 

Use medical billing software 

Non emergency medical transportation billing software is the way of the future, and for good reason. There are a variety of billing software options available, and they all seek to reduce rejected and denied claims. By scrubbing all claims for errors before submission, software ensures the claims you’re sending off are error-free. 

Say bye to denied claims for good

You want the best for your medical practice, and software is a great way to get you there. Billing software is designed to make your job easier, faster, and more accurate. If you’re ready to explore what software option is right for your business, get in touch with the crew at iSi Technology for more information. We can’t wait to chat with you!