Posted on August 6th, 2024

Insurance reimbursements, received in a timely manner, are crucial for maintaining your practice - to pay staff, buy supplies, and treat patients.

Therefore, it can be really frustrating when medical claims are denied since they can for 30% or more of a practice's billing. 

At Providers Choice, our team understands the importance of minimizing denied claims.

To prevent denials, it's essential to understand their causes. By doing so, you can work with your team to avoid the errors that lead to denied claims.

Here are the top 5:

1. Prior Authorization Was Required: Some medical claims are denied because prior authorization is needed from the insurance company. Procedures like MRIs and CT scans may require pre-authorization. Always confirm with the insurance company to avoid denials.
2. Missing or Incorrect Information: Human errors happen. Double-check and triple-check information on medical claims to avoid denials. Claims may be rejected due to missing information, such as a service code, or inaccuracies like misspelled patient names and incorrect subscriber IDs.
3. Outdated Insurance Information: Keep patient records updated to prevent denials due to outdated insurance information. Confirm if patients have changed jobs or have updated insurance cards. This ensures the claim is sent to the correct insurer, saving time and frustration.
4. Claim Was Filed Too Late: Submit medical claims promptly to avoid denials. Insurance companies often have a specific window for claim submissions. Waiting too long can result in denial. Establish a process in your office to ensure timely billing of all claims.
5. Failure to Verify Coverage: Ensure that patient insurance coverage is verified before providing services. Without proper coverage, claims are likely to be denied. Take the time to verify insurance details upfront to prevent issues later on.