Claim denials quietly erode practice revenue, and the frustrating part is that most of them are preventable. After reviewing thousands of denied claims, we consistently see the same root causes.
Eligibility and benefits not verified. Submitting a claim without confirming active coverage is the single most common denial driver. A 30-second verification at check-in prevents it.
Coding errors and mismatches. Incorrect, outdated, or mismatched ICD-10 and CPT codes trigger automatic rejections. Certified coders and real-time scrubbing catch these before submission.
Missing or late authorizations. Many payers require prior authorization for specific services. Track requirements by payer and obtain authorizations before the encounter.
Timely filing limits. Claims that age past the payer's filing window are denied outright with no appeal. Systematic follow-up keeps every claim moving.
Incomplete documentation. Claims must be supported by clear clinical documentation. Aligning documentation with billed services protects both revenue and compliance.