Top 3 Reasons Your Claims Get Denied

Below is a nice summary on why a number of our insurance claims get denied.  Fortunately, they are basic mistakes that can be corrected quickly.  It is a re-post of information from the American Academy of Professional Coders (AAPC).

Click on image for claim form instructions

Click image for ADA 2013 claim form instructions

There are plenty of reasons an insurer might deny your claims, but the most common billing errors are also the simplest and easiest to correct. Here are the top 3:

1. Incorrect and/or incomplete patient identifier information (e.g., name spelled incorrectly; date of birth or soc. sec. number doesn’t match; subscriber number missing or invalid; insured group number missing or invalid)

Solution: Verify patient demographic and insurance information at EVERY visit. Ask permission to photocopy the patient’s state-issued identification (passport, drivers license, etc.) and insurance card, so that you are sure to have the proper spelling, group numbers, etc., on hand.

2. Coverage terminated

Solution: Verify insurance benefits prior to services being rendered. 

3. Services non-covered/Require prior authorization or precertification

Solution: Here again, you should contact the patient’s insurance and confirm coverage prior to services being rendered. You’ll end up with angry customers if you bill a patient for non-covered charges without making them aware that they may be responsible for the charges before their procedure.

Sign up to receive my blog posts via e-mail and get a copy of my newsletter for FREE.