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Stop Denials and Start Collecting: Mastering Denial Code 129

Understanding Denial Code 129 Denial code 129, often stated as “Prior processing information appears incorrect,” arises when secondary or tertiary insurers identify discrepancies in claim data. This typically results from inaccuracies such as missing patient information, claim data mismatches, or payment processing errors. If not addressed, these denials can impact the revenue cycle of healthcare practices, […]

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Denial Code 236: Master NCCI and State Rules for Revenue.

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Denial code 236 is a significant roadblock for healthcare providers, often caused by violations of the National Correct Coding Initiative (NCCI) guidelines or state-specific workers’ compensation regulations. This denial indicates that a procedure or procedure/modifier combination is incompatible with another service billed on the same day. Understanding how to navigate these coding rules is essential

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Cracking the Code: Preventing Denial Code 39

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Denial Code 39, which states “Services denied at the time authorization/precertification was requested,” is a frequent challenge healthcare providers face. This denial typically arises when medical procedures are performed without obtaining the necessary prior approval from the insurance carrier. Why Does Denial Code 39 Occur?Several factors can lead to Denial Code 39, including: Strategies to

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Mastering the CMS-1500

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The CMS-1500 form, previously known as the HCFA-1500, is a standardized document that healthcare providers use to submit claims for reimbursement to government insurance plans like Medicare, Medicaid, and Tricare. This crucial form captures essential details about the patient, provider, services rendered, and insurance coverage, ensuring accurate and efficient claim processing. Key Sections of the CMS-1500The CMS-1500 form is divided into

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Stop the Revenue Drain: Preventing Denial Code 31

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Denial code 31, “Patient cannot be identified as our insured,” is a frequent issue that can disrupt a healthcare practice’s revenue cycle. This denial occurs when there’s a mismatch between the patient information provided on the claim and the insurer’s records. To avoid these costly denials, it’s essential to understand the root causes and implement

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Denial Code 256: A Major Threat to Your Practice’s Revenue

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Denial Code 256, indicating a service not payable per the managed care contract, is a significant obstacle for healthcare providers. This denial signifies that the specific service provided is not covered by the terms of the contract between your practice and the patient’s insurance company. Understanding the Root Causes of 256 Denials Several factors can

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Denial Code 519: A Major Threat to Your Practice’s Revenue

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Denial Code 519, indicating an invalid combination of Healthcare Common Procedure Coding System (HCPCS) modifiers, is a significant obstacle for healthcare providers. This denial signifies that the modifiers used on the claim are not valid or appropriate for the specific procedure or service billed. This can lead to claim denials, delayed payments, and a significant

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Denial Code MA120: A Major Threat to Your Laboratory’s Revenue

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Denial Code MA120 is a significant obstacle for laboratories, indicating a missing, incomplete, or invalid CLIA certification number on the claim. This denial signifies that the laboratory may not be authorized to perform the billed service, leading to claim rejections, delayed payments, and a significant impact on your practice’s revenue. Understanding the Root Causes of

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

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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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Denial Code B11: Overcoming “Not Covered” Claims & Boosting Your Revenue

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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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