September 2024 Archives |

Denial Code 256: Fix Managed Care Claim Rejections

Leave a Comment / September 2024

For healthcare providers, Denial Code 256 creates unnecessary revenue loss when claims are denied for services excluded under managed care contracts. These rejections typically occur due to contract limitations or authorization issues, but with proper protocols, they can be prevented. Key Reasons for 256 Denials Contractual Restrictions Authorization Failures Benefit Limitations 5-Step Prevention Strategy 1. Master Your […]

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TCHP Medicaid Loss: Provider Impact & Solutions

Leave a Comment / September 2024

The TCHP Medicaid loss creates urgent challenges for Southeast Texas providers serving nearly 450,000 affected members. This transition threatens revenue stability and care continuity, but proactive strategies can minimize disruption to your practice. Immediate Impacts to Address Financial Risks Operational Challenges Patient Care Concerns 4-Step Transition Plan 1. Secure New Contracts 2. Protect Your Revenue 3. Communicate

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Denial Code 519: Fix Invalid Modifier Combinations

Leave a Comment / September 2024

For healthcare providers, Denial Code 519 creates unnecessary payment delays when claims contain incompatible or incorrect HCPCS modifiers. These preventable denials stem from modifier application errors – but with proper systems, they can be eliminated. Why Modifier Denials Occur Payers issue Code 519 when: Top 5 Causes 5-Step Prevention System 1. Implement Modifier Checks 2. Enhance Staff

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Fix MA120 Denials: Avoid CLIA Certification Claim Rejections

Leave a Comment / September 2024

For practice managers, healthcare providers, and lab owners, MA120 denials can be a major roadblock to revenue. This denial code indicates a missing, incomplete, or invalid CLIA certification number on a claim, meaning your lab may not be authorized to perform the billed service. Left unchecked, these denials lead to delayed payments, increased administrative work, and lost revenue. Let’s break

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Denial Code N258: A Major Threat to Your Practice’s Revenue

Leave a Comment / September 2024

enial Code N258, indicating an incorrect or missing provider address on the claim, is a significant obstacle for healthcare providers. Misrouted claims due to incorrect address information can lead to delayed payments, increased administrative burdens, and ultimately, a significant impact on your practice’s revenue. Understanding the Root Causes of N258 Denials Several factors can contribute

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B11 Denial Code: Causes & Solutions for Service Not Covered

Leave a Comment / September 2024

Denial Code B11 is a common and frustrating challenge for healthcare providers, indicating that the service billed is not covered by the patient’s insurance plan. This denial, often accompanied by the phrase “service not covered,” can significantly impact your practice’s revenue and increase administrative burden. Understanding the Root Causes of B11 Denials Several factors can

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Fix B23 Denials: Resolve CLIA Proficiency Testing Claim Rejects

Leave a Comment / September 2024

For practice managers, lab owners, and healthcare providers, B23 denials signal a critical compliance issue: your claim indicates the test wasn’t authorized under your CLIA proficiency testing requirements. These denials disrupt cash flow, increase administrative workload, and risk revenue loss. Here’s how to identify, prevent, and resolve B23 denials effectively. Why B23 Denials Occur Key triggers for

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Denial Code N216: A Persistent Threat to Your Revenue

Leave a Comment / September 2024

Denial Code N216 is a common and frustrating challenge for healthcare providers, indicating that the services rendered were not covered by the patient’s insurance plan. This denial often stems from benefit exclusions, leading to claim rejections, delayed payments, and a significant impact on your practice’s revenue. Understanding the Root Causes of N216 Denials Several factors

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Fix Denial Code 129: Stop Secondary Claim Rejections

Leave a Comment / September 2024

Denial Code 129 (“Prior processing information appears incorrect”) creates unnecessary revenue cycle friction. This secondary/tertiary payer rejection occurs when claim data doesn’t match previous submissions, costing practices an average of $47 per claim in rework, according to recent MGMA data. Top 5 Causes of Code 129 Denials Proven Fixes for Code 129 Denials 1. Implement

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Stop M127 Denials: Fix Missing Medical Record Issues Fast

Leave a Comment / September 2024

M127 appears when insurers deny claims due to missing medical records needed to prove medical necessity. Common triggers include: Because insurers strictly enforce documentation rules, even minor oversights can lead to denials. Fortunately, with proper systems in place, you can significantly reduce M127 rejections. Top 5 Causes of M127 Denials (With Solutions) 1️⃣ Incomplete or Missing Documentation Problem: Claims get denied

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