Every denied claim delays your cash and costs staff time to rework, and many denials are never resubmitted at all. The good news: most denials are preventable. Here are the most common causes we see and how to stop them.
1. Eligibility and coverage issues
Inactive coverage, wrong payer or missing secondary insurance. Fix: verify eligibility 48–72 hours before every visit and again for recurring patients each month.
2. Missing prior authorization
Services billed without a required approval. Fix: maintain a payer-by-payer authorization list and track approval numbers and expiry dates.
3. Coding errors
Mismatched diagnosis and procedure codes, missing modifiers or outdated codes. Fix: code from documentation and run claims through edit checks before submission.
4. Demographic and data-entry mistakes
A wrong date of birth or member ID is enough for a rejection. Fix: double-check registration data and scan insurance cards at every visit.
5. Duplicate claims
Resubmitting instead of correcting or checking status. Fix: check claim status first, then send a corrected claim with the right frequency code.
6. Timely filing limits
Every payer has a deadline, sometimes as short as 90 days. Fix: track filing limits by payer and work aged claims weekly.
7. Medical necessity
The diagnosis does not support the service under payer policy. Fix: review coverage policies (LCDs/NCDs) for high-value services.
Want to know your own denial patterns? Request a free billing audit and we will show you where your claims are getting stuck.
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