3 Reasons Health Insurance Claims Are Denied

Most claim denials are due to errors made when you verify patients’ benefits. Over 90% of claim denials are avoidable. It is really important that you not skip the insurance verification process at your clinic. This is a crucial step in making sure you get paid in full. 

It is important for you as the owner to make sure you train your staff on how to do verifications properly. Or you can outsource verifying your patient benefits to One Body which can help by doing a thorough analysis of  patients’ benefits.

Below are three reasons your claims are being denied:

1) Missing Information

Over 60% of claims denied were due to missing information. If your claim is missing information or has incorrect information (ie incorrect medical billing code) it can lead you to miss the claim submission deadline and not get reimbursed for the services you provided patients.

2) Service Not Covered

CPT codes and service types should always be checked before seeing a patient to make sure his/her insurance plan covers the services you are offering. About 20% of claims are denied due to excluded services.

3) Deadline Not Met

All claims must be submitted after a certain number of days after service is rendered. This due date includes all adjustments and resubmissions so make sure you are aware of the deadlines to submit claims.

If you need help with verifying your patients’ benefits, please contact One Body at hello@onebodywellness.com. One Body has 30+ years experience verifying benefits for clinics.