ClaimsProcessing

How to Overcome M86 Denials in Medical Billing: Smart Tactics for Revenue Recovery

Leave a Comment / Denial Management, May 2025

One of the most common and frustrating obstacles in healthcare billing is dealing with denied claims—especially those tagged with Reason Code M86 denials. This denial states: “Service denied because payment already made for same/similar procedure within set time frame.” For healthcare providers, understanding why this happens and how to prevent it is crucial to maintaining […]

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N381 Denial Code: How to Prevent Revenue Leaks

Leave a Comment / April 2025, Denial Management

Understanding the N381 Denial Code Are you a healthcare provider, practice manager, or medical business owner constantly battling the N381 denial code? You’re not alone. This common denial indicates that the claim doesn’t meet the terms of your payer contract—leading to frustrating delays and lost revenue. Let’s break it down and help you turn this

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Understanding and Overcoming Denial Code N657

Leave a Comment / April 2025

Denial Code N657 — “This should be billed with the appropriate code for these services” — is a common obstacle in healthcare billing that can severely impact reimbursement and cash flow. This denial signals coding mismatches, missing information, or outdated practices that healthcare providers must swiftly address to maintain a healthy revenue cycle. Common Reasons

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N450 Denial Code

N450 Denial Code: Strategies to Prevent and Recoup Revenue

Leave a Comment / Denial Management, January 2025

The N450 denial code is a common issue faced by healthcare providers. It signifies that the service billed was covered only when performed by the primary treating physician or their designated representative. This denial often arises due to various reasons, including: Common Causes of N450 Denials Strategies to Prevent N450 Denials To mitigate the risk

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Denial Code 55

Denial Code 55: Addressing Experimental Procedure Denials for Improved Revenue

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Denial code 55 is a significant revenue challenge for healthcare providers, indicating that a procedure, treatment, or drug is deemed experimental or investigational. This article will explore the causes of these denials, strategies to prevent them, and steps to take if your practice encounters this issue. Understanding Denial Code 55 When a claim is denied

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PR279 denials

Tackling PR279 Denials: Ensuring Network Compliance and Boosting Revenue

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Insurance denials are a persistent challenge for healthcare providers. Denial code PR279, indicating services not provided by preferred network providers, is a common culprit that can significantly impact your practice’s revenue. This guide will equip practice managers, healthcare providers, and owners with the knowledge to prevent and address these denials effectively. Understanding Denial Code PR279

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N216 denials

Overcoming N216 Denials: Ensuring Patient Enrollment and Maximizing Revenue

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Receiving a N216 denial can be a significant setback for healthcare providers, practice managers, and owners. This denial code, indicating the patient isn’t enrolled in the relevant portion of the benefit package, often leads to revenue loss and increased administrative burdens. Understanding the root causes of N216 denials is the first step to overcoming this

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M42 denials

Preventing M42 Denials: Ensure Proper Signatures on Medical Necessity Forms

Leave a Comment / Denial Management

Are you experiencing a surge in claim denials due to Reason Code M42? This common denial stems from a missing or invalid signature on the medical necessity form. Such denials can significantly impact your revenue cycle and overall financial health. Understanding the causes of M42 denials and implementing actionable solutions is essential for practice managers

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clearinghouse rejections

Clearinghouse Rejections: How to Avoid Them and Maximize Revenue

Leave a Comment / Healthcare

Healthcare providers and practice managers often face the frustrating challenge of clearinghouse rejections. These aren’t denials; they’re opportunities to rectify errors and ensure timely claim payments. By understanding the common causes of these rejections and implementing effective solutions, you can streamline your revenue cycle and improve your bottom line. Why Are My Claims Getting Rejected?

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MA37 denials

Prevent MA37 Denials: Ensure Accurate Patient Address Information

Leave a Comment / Denial Management

One of the most common reasons for claim denials in the healthcare industry is missing, incomplete, or invalid patient address information, often coded as MA37. These denials can lead to significant revenue losses for practices. Understanding the causes of MA37 denials and implementing actionable solutions is crucial for practice managers to prevent and address them

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