Every denied claim is money you already earned, waiting. Most denials come from a handful of fixable causes. Catch them before the claim goes out and you get paid faster with less rework.
Eligibility and coverage
Inactive policies and wrong plans cause a large share of denials. Verify coverage before every visit, not just the first one.
Missing or incorrect information
A misspelled name, wrong date of birth or missing modifier is enough. Scrub claims before submission.
The cheapest denial to fix is the one that never happens.
Prior authorization
Some services need approval in advance. Keep a list of which payers require it for which services, and track approvals.
Timely filing
Each payer has a deadline. Submit claims promptly and watch for anything sitting unsent.
Track the reason, fix the cause
Grouping denials by reason shows patterns. Fix the process, not just the claim. MDClaim360 shows denials by reason so patterns stand out.
What to do next
- Pull last quarter's denials and group them by reason.
- Fix the top two causes first.
- Work every open denial within a week.