ClaimsMed

referral-related denials prevention

How to Prevent Referral-Related Denials in Healthcare Billing

Leave a Comment / August 2024, Denial Management, Healthcare

Referral-related denials are a common frustration for healthcare providers, practice managers, and healthcare owners. These denials occur when claims are submitted without proper referral documentation, affecting reimbursement and delaying patient care. In this article, we’ll discuss the most common causes of referral-related denials and how to implement effective strategies to prevent them. What Causes Referral-Related […]

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Denial code N115

Denial Code N115: Understanding & Preventing Medical Necessity Claim Denials

Leave a Comment / August 2024, Denial Management

Denial code N115 occurs when a service or item is not deemed medically necessary based on a Local Coverage Determination (LCD) or Local Medical Review Policy (LMRP). These denials can lead to lost reimbursements, delayed payments, and administrative burdens for healthcare providers, billing teams, and practice managers. By understanding why N115 denials happen and implementing

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CO-167 denials

How to Avoid CO-167 Denials and Ensure Timely Reimbursements for Your Practice

Leave a Comment / August 2024, Denial Management

Claim denial code CO-167 can be a significant roadblock in the reimbursement process, as it indicates that the service provided wasn’t covered under the patient’s insurance plan. Understanding the common reasons for CO-167 denials and implementing strategies to prevent them can help ensure smoother billing, faster reimbursements, and improved cash flow for your practice. What

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Denial codes CO242 and CO243

Denial Codes CO242 & CO243: Causes, Prevention & Revenue Optimization

Leave a Comment / August 2024, Denial Management

Denial codes CO242 and CO243 occur when a service is not authorized by the network or primary care provider (PCP). These denials impact cash flow, delay reimbursements, and increase administrative burdens. For practice managers, healthcare providers, and billing teams, understanding the root causes of these denials and applying preventative strategies is essential for reducing claim

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Denial code CO119

Denial Code CO119: How to Prevent Benefit Maximum Denials & Improve Reimbursements

Leave a Comment / August 2024, Denial Management

Denial code CO119 occurs when a patient has reached the maximum allowable benefit for a specific service or time period. These denials can lead to revenue losses, administrative burdens, and patient dissatisfaction. For healthcare providers, practice managers, and billing teams, understanding why CO119 occurs and implementing preventative strategies is essential for minimizing claim rejections and

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Coordination of Benefits

Mastering Coordination of Benefits (COB) to Prevent CO-22 Denials and Maximize Reimbursement

Leave a Comment / August 2024, Denial Management

As a healthcare provider, navigating Coordination of Benefits (COB) can feel like solving a complex puzzle. When patients have multiple insurance plans, determining which payer is primary and which is secondary is crucial to getting paid. Incorrectly managing COB can lead to claim denials, particularly with the CO-22 code, which often stems from issues related

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Denial Code 49: How to Prevent Routine Exam Exclusions and Maximize Reimbursements

Leave a Comment / August 2024, Denial Management, Healthcare

Denial code 49 occurs when a service is considered routine or part of a preventive exam and is not covered by insurance. These denials can disrupt cash flow, delay reimbursements, and increase administrative burdens. For practice managers, healthcare providers, and billing teams, understanding the root causes and implementing preventative solutions is essential for reducing claim

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Denial Code 96

Denial Code 96: Understanding and Preventing Non-Covered Service Denials

Leave a Comment / August 2024, Denial Management

Denial code 96 is issued when a billed service, procedure, or item is not covered under a patient’s insurance plan. These denials can result from policy exclusions, incorrect coding, or lack of pre-authorization, leading to payment delays and lost revenue for healthcare providers. For practice managers, billing teams, and healthcare providers, understanding the root causes

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Denial code 131

Denial Code 131: How to Prevent Revenue Loss and Optimize Your Billing Process

Leave a Comment / August 2024, Denial Management

Denial code 131, “Claim specific negotiated discount,” is a frequent yet avoidable issue for healthcare providers and practice managers. Left unresolved, it can significantly impact revenue cycles, leading to lost reimbursements and financial strain. By understanding its root causes and implementing proactive solutions, you can enhance claim approval rates and strengthen your practice’s financial health.

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