A denied healthcare insurance claim is an extremely frustrating thing for medical billing companies or managers. Apart from wasting the time of patients, administrators, and physicians filing invalid claims also seems like a money-pit. There can be different reasons behind denial codes in medical billing. Some of them include billing errors, patient coverage questions, missing information, etc. In this blog post, we will share 5 common reasons that can be behind a denial medical billing code.
Common Denial Codes in Medical Billing
Let’s take a look at the five most common causes of claim denials along with their reasons in medical billing.
1. Missing Information
If some information about the patient is missing, it will end up in a denial. Even if you leave one field empty, it will result in claim denial. Approximately 42% of all denial claims are due to this issue. Examples can be:
- Missing SSN
- Wrong plan code
- Technical and demographic errors, such as missing modifiers
Therefore, it is essential to enter complete patient information for perfect insurance claim submission.
2. Duplicate Claims
Duplicates are claims that you submit for one encounter with one provider (same day) for a patient with the same service. Around 32% of all denial codes in medical billing are due to this issue. Therefore, it is essential to avoid duplicate claims.
3. An Already Adjudicated Service
Denials will also occur for already adjusted services. This type of denial happens when assistance for a certain service is available in another procedure’s or service’s payment that is already made available.
4. An Uncovered Procedure by the Payer
If the payer has not covered a procedure, it will result in claim denial. Therefore, it is essential to cover procedures under the recent benefit plan of the patient. Providers can avoid these denials very easily. They should simply call the insurer before they submit claims.
5. Filing Limit Expiry
One of the common types of denial codes in medical billing happens because of filing limit expiry. If you don’t file a claim within the required service days of the payer, it will result in a denied claim. Therefore, it is essential to file claims on time.
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