Practice managers, healthcare providers, and owners know MA67 denials (“Correction to a prior claim”) create more than just paperwork headaches. These frustrating rejections delay payments, drain staff resources, and ultimately hurt your bottom line. Therefore, by understanding how to establish systematic MA67 denial code prevention, you can protect your practice’s financial health while streamlining operations.
Consequently, mastering claim data integrity is essential for avoiding unnecessary payer scrutiny and rework.
Top Reasons for MA67 Denials (The Rework Loop)
The MA67 denial code signals: “The service has been adjusted based on information received in a corrected claim.” This means a prior claim had errors (e.g., wrong dates, wrong primary payer, incorrect NPI) and when you submitted the corrected version, the payer adjusted the claim based on the new, updated data. While this may result in a final payment, the denial code itself represents the cost of the rework cycle.
Common Causes of MA67 Denials
MA67 rejections stem from incorrect or mismatched data on claims. Addressing these upstream errors is key to MA67 denial code prevention.
- Patient Data Errors: The foundational failure involves mismatched data. First, check for name/DOB mismatches between the EHR and the insurance file. Next, verify that insurance IDs are current. Finally, confirm coverage hasn’t expired.
- Billing Mistakes: Procedural errors guarantee rework. Duplicate claims frequently trigger rejections. Equally problematic, wrong primary/secondary payer designations violate Coordination of Benefits (COB) rules. Additionally, late filings often lead to automatic denials that require corrected resubmission.
- Provider & Service Issues: Flaws in provider information or authorization cause delays. Missing credentials create unnecessary hurdles. Similarly, non-covered services guarantee rejections. Finally, incomplete documentation compounds these problems by failing to justify the service on the corrected claim.
- Incorrect Resubmission Method: The original claim was denied, and the billing team submits a new claim instead of using the correct resubmission code (Type of Bill 7) or frequency code (e.g., ‘7’ for replacement). This forces the payer to deny the new claim as a duplicate, leading to MA67 on the subsequent corrected claim.
7 Proven Strategies for MA67 Denial Code Prevention
Implementing proactive, systematic strategies will stop the rework loop and eliminate MA67 adjustments.
1. Implement Automated Claim Scrubbing (The Tech Barrier)
Rather than relying on manual reviews, invest in AI-powered software that automatically flags errors before submission. These advanced systems catch duplicates, missing required data, and compliance issues with remarkable accuracy. Crucially, the scrubber must be configured to check for correct resubmission codes if the claim is not the first attempt.
2. Standardize Patient Verification
During patient intake, make insurance eligibility verification mandatory. Train staff to cross-check all demographics (Name, DOB, ID) against the EHR and the payer’s eligibility response to prevent simple front-end mistakes that lead to denials.
3. Master Payer-Specific Rules and COB
Since each insurer has unique requirements, track their correction policies carefully. Furthermore, train staff thoroughly on the coordination of benefits to avoid hierarchical errors. Specifically, verify which payer is Primary, Secondary, and Tertiary before the first submission.
4. Improve Documentation Practices
Complete records prove medical necessity. Therefore, ensure documentation includes all required authorizations. Moreover, attaching proper modifiers (like -25 or -59) strengthens your claims significantly, reducing the chance of the initial denial that triggers the MA67 rework.
5. Create a Denial Management System
Track denial trends by specific code and payer. By tracking denial trends, you can identify problematic patterns (e.g., a specific CPT code frequently denied for lack of authorization) early. Subsequently, develop standardized appeal processes to resolve issues efficiently and learn from the error.
6. Enforce Correct Resubmission Protocol
Train your billing staff never to submit a “corrected” claim as a “new” claim. They must always use the appropriate frequency code (often ‘7’) and reference the original claim number on the resubmission. This streamlines the payer’s process and reduces the need for manual adjustment.
7. Conduct Regular Billing Audits
Perform periodic internal audits of claims that typically require corrections (e.g., claims with multiple modifiers). This proactive review catches the systematic errors that cause the initial denial, thereby preventing the MA67 adjustment.
Need Expert Help Reducing Denials?
While stopping MA67 denials requires precision and expertise, you don’t have to tackle this challenge alone. At Claims Med, we specialize in healthcare revenue cycle management.
Contact Claims Med today for a free revenue cycle assessment and start keeping more of your hard-earned revenue.