Top 5 Reasons For Claim Denials! You Cash In On Your Medical Practice

Though physicians are very careful in filing the claims to the payer, still most of their claims are denied.

Here are top 5 reasons for claim denials which most physicians face but either realise later or are not able to figure out:

Duplicate claims:

Have you ever tried to resubmit a claim for which you have not received any response? If yes then you shouldn’t, as it creates confusion for the payer and may ending up as a duplicate claim.

Claims/service lacks information:

Make sure you get CO16 code which says information is incomplete to process the claims. A remark code is required for additional information.

Benefit for this service is included in the payment:

The insurance company denies the claim for a service as it has already paid for another service on the same date (as a part of bundled service).

At least one remark code must be provided:

This may include either a Remittance Advice Remark Code or NCPDP Reject Reason Code.

The time limit for filing has expired:

The maximum filing limit of Medicare is 2 years and minimum 1 year. If you have filed your claim within the time limit then appeal it with a required proof.