HealthcareManagement

Navigating Medicaid Contract Delays: Impact on Provider Credentialing.

Texas recently announced a delay in awarding new Medicaid contracts until June 2025, a decision affecting nearly 1.8 million beneficiaries across the state. This pause, initiated after a court injunction, allows lawmakers to review criteria impacting health plans, including three nonprofit hospital-affiliated plans. While the focus is on managed care restructuring, the ripple effects extend […]

Navigating Medicaid Contract Delays: Impact on Provider Credentialing. Read More »

Navigate CO9 Denials: Prevention and Resolution Strategies.

CO9 denials, which result from inconsistencies between diagnosis codes and procedures, are a frequent challenge in healthcare billing. For healthcare providers, practice managers, and owners, these denials can disrupt revenue flow. This guide explains the causes, prevention strategies, and steps to resolve CO9 denials effectively. Common Causes of CO9 Denials Strategies to Prevent CO9 Denials

Navigate CO9 Denials: Prevention and Resolution Strategies. Read More »

Denial Code 273: A Guide to Coverage and Program Limits.

Understanding Denial Code 273Denial code 273, “Coverage/program guidelines were exceeded,” highlights claims that fail to meet the insurer’s coverage criteria. These denials can disrupt your revenue cycle, but understanding the reasons behind them can help healthcare providers address and prevent such issues effectively. Common Causes of Denial Code 273 Strategies to Prevent Denial Code 273

Denial Code 273: A Guide to Coverage and Program Limits. Read More »

Master Remark Code MA61: Prevent Denials from Invalid SSNs.

Understanding Remark Code MA61Remark Code MA61 is a frequent cause of claim denials, indicating issues with a missing, incomplete, or invalid Social Security Number (SSN) or health insurance claim number. This denial can result in delayed payments and revenue losses for healthcare providers. This article covers the common causes of MA61 denials and strategies to

Master Remark Code MA61: Prevent Denials from Invalid SSNs. Read More »

Denial Code CO7: Avoid Gender-Inconsistent Procedure Denials.

Understanding Denial Code CO7Denial Code CO7 is an insurance denial indicating that a procedure or revenue code does not match the patient’s recorded gender, often leading to rejections that impact a healthcare provider’s revenue cycle. This guide offers insights and strategies for preventing CO7 denials to improve claims acceptance and streamline the revenue cycle. Common

Denial Code CO7: Avoid Gender-Inconsistent Procedure Denials. Read More »

Mastering Procedure Codes: How to Avoid N56 Denials

Understanding Remark Code N56For healthcare providers and practice managers, Remark Code N56 can be a recurring headache. This denial code indicates that the procedure code submitted is either incorrect or invalid for the specific service rendered or date of service, resulting in claim rejections and potential revenue loss. Learning to avoid N56 denials is key to maintaining

Mastering Procedure Codes: How to Avoid N56 Denials Read More »

Tackle Denial Code N623: A Complete Guide for Providers.

Denial code N623, indicating “Not covered when deemed unscientific, unproven, outmoded, experimental, excessive, or inappropriate,” is a frequent cause of reimbursement denials in healthcare. This code signifies that the payer believes the service provided does not meet established medical standards or lacks scientific backing. For healthcare providers, understanding this denial code and implementing strategies to prevent

Tackle Denial Code N623: A Complete Guide for Providers. Read More »

M26 Denials: A Comprehensive Guide for Prevention

Remark code M26 often indicates that a healthcare claim lacks sufficient justification for the billed service level, leading to denials that can impact a practice’s revenue significantly. Addressing these issues requires understanding common causes and implementing proactive measures to avoid denials. Common Reasons for M26 Denials Strategies to Prevent M26 Denials Preventing Denials with Claims MedClaims Med offers

M26 Denials: A Comprehensive Guide for Prevention Read More »

Master Denial Code136: Ensure Compliance with Payer Coverage Rules.

Denial code 136, indicating “Failure to follow prior payer’s coverage rules,” is a frequent challenge in medical billing that can impact your practice’s revenue significantly. This denial code is commonly associated with Group Code OA, used when claims are submitted to a secondary payer. Avoiding these denials requires a clear understanding of the primary payer’s

Master Denial Code136: Ensure Compliance with Payer Coverage Rules. Read More »