Common Reasons for Claim Denials

Hi, this is Amber Darst, Solutions Manager at Managed Outsource Solutions, here to talk to you today about some common reasons for claim denials.

00:10 Common Reasons for Denials

Receiving a claim denial is so frustrating and there are several things that can lead to this happening. Here’s a short list of some of the most common reasons a claim can be denied.

00:22 Coverage Limits – If the patient has already reached their allowed benefits for the procedure that’s listed on the claim for the benefit year, there will be zero payment from the insurance company. It’s very important to note the frequencies and limitations for each patient’s plan.

00:40 Data Entry Errors– Having the data of birth or member ID wrongly inputted into the system, which is then printed on to the claim, will be certain to cause a claim denial.

00:51 Next, Outdated Insurance Information – Insurance plans change and oftentimes patients aren’t even aware submitting to a term policy. This will result in a claim denial.

01:04 And Last, Issues In Coordination of Benefits– Not knowing which insurance is primary and which is secondary when a patient has more than one active policy can create an issue when submitting claims. If you submit the initial claim to the secondary first,denial is likely to occur.

01:23 How Insurance Verification Helps

The good news is that these scenarios can be avoided by ensuring that each patient has insurance verification completed before the date of service. Checking all of the above information with the insurance companies ahead of the appointment is the most productive way of reducing claim denials, resulting in maximum reimbursement.

And that’s all! Thanks for listening in.