Common Reasons for Claim Denials

by | Last updated Jun 5, 2023 | Published on Mar 4, 2022 | Podcasts, Insurance Verification/ Authorizations (P) | 0 comments

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Practices need comprehensive insurance verification services to determine patient coverage and benefits before the office visit.

Outsource Strategies International (OSI) has vast experience in working with insurance companies to confirm patient insurance eligibility and coverage.

In today’s podcast, Amber Darst, one of our Solutions Managers discusses the common reasons for claim denials.

Podcast Highlights

00:10 Common Reasons for Denials

00:22 Coverage Limits

00:40 Data Entry Errors

00:51 Outdated Insurance Information

01:04 Issues In Coordination of Benefits

01:23 How Insurance Verification Helps

Read Transcript

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00:51 Next, Outdated Insurance Information – Insurance plans change and oftentimes patients aren’t even aware submitting to a term policy.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

Amber Darst

Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. With a rich background in dental services, her expertise ranges from insurance coordination to office management.

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