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Avoiding Medical Insurance Denials

Denials vs Rejections

We know how frustrating it can be to submit a claim only to have it denied. It makes you want to pull your hair out (unless, like me, you don't have any).

This blog is all about what you can do to minimize denials.

Let's start at the very beginning: denials versus rejections.

A rejection is what happens when the payer can't understand a claim. For example, a provider used an invalid procedure code, which means no one can be sure what the claim is for.

A denial occurs when the claim is properly entered and the payer understands what you submitted, but refuses to pay. When that happens you get an EOB (Explanation of Benefits) with a reliably obscure code to explain the reason for the denial.

The Coding Advisor can help you with both of these problems. We'll explain more in our next blog post, so stay tuned.

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