RevenueOptimization

Denial Code 31

Denial Code 256: Fix Managed Care Claim Rejections

Leave a Comment / September 2024

For healthcare providers, Denial Code 256 creates unnecessary revenue loss when claims are denied for services excluded under managed care contracts. These rejections typically occur due to contract limitations or authorization issues, but with proper protocols, they can be prevented. Key Reasons for 256 Denials Contractual Restrictions Authorization Failures Benefit Limitations 5-Step Prevention Strategy 1. Master Your […]

Denial Code 256: Fix Managed Care Claim Rejections Read More »

Denial Code 519

Denial Code 519: Fix Invalid Modifier Combinations

Leave a Comment / September 2024

For healthcare providers, Denial Code 519 creates unnecessary payment delays when claims contain incompatible or incorrect HCPCS modifiers. These preventable denials stem from modifier application errors – but with proper systems, they can be eliminated. Why Modifier Denials Occur Payers issue Code 519 when: Top 5 Causes 5-Step Prevention System 1. Implement Modifier Checks 2. Enhance Staff

Denial Code 519: Fix Invalid Modifier Combinations Read More »

MA120 Denials

Fix MA120 Denials: Avoid CLIA Certification Claim Rejections

Leave a Comment / September 2024

For practice managers, healthcare providers, and lab owners, MA120 denials can be a major roadblock to revenue. This denial code indicates a missing, incomplete, or invalid CLIA certification number on a claim, meaning your lab may not be authorized to perform the billed service. Left unchecked, these denials lead to delayed payments, increased administrative work, and lost revenue. Let’s break

Fix MA120 Denials: Avoid CLIA Certification Claim Rejections Read More »

Out-of-Network Denials

Out-of-Network Denials: Reduce Revenue Loss

Leave a Comment / August 2025

Out-of-network denials are a common and costly challenge for healthcare providers, practice managers, and clinic owners. These denials happen when services are delivered by providers who are not contracted with the patient’s insurance plan. The result? Significant revenue loss for your practice and steep out-of-pocket costs for patients. Understanding why out-of-network denials occur and how

Out-of-Network Denials: Reduce Revenue Loss Read More »

Denial Code CO-27

Fix Denial Code CO-27: Prevent Expired Coverage Denials

Leave a Comment / July 2024

For practice managers and healthcare providers, maintaining a healthy cash flow is a constant priority. Consequently, Denial Code CO-27—a claim rejection for services rendered after a patient’s coverage ended—poses a significant and frustrating threat to your revenue cycle. These denials directly translate into lost revenue, wasted administrative hours, and strained patient relationships. The good news, however,

Fix Denial Code CO-27: Prevent Expired Coverage Denials Read More »

Denial Code CO-16

Fix Denial Code CO16: Stop Missing Info Claim Denials

Leave a Comment / July 2024

For practice managers and healthcare providers, a smooth revenue cycle is essential for financial stability. Consequently, Denial Code CO16—a rejection for missing or incomplete information—creates frustrating payment delays and unnecessary administrative work. The good news is that since these denials are purely administrative, you can prevent them entirely with the right systems and protocols. Mastering how

Fix Denial Code CO16: Stop Missing Info Claim Denials Read More »

ICD-10 Excludes

Master ICD-10 Excludes Notes: Prevent Costly Claim Denials

Leave a Comment / July 2024

For practice managers and healthcare providers, navigating the intricate world of ICD-10 coding is a fundamental part of ensuring a healthy revenue cycle. Among the most persistent challenges are the ICD-10 Excludes notes. Misinterpreting these critical guidelines is a direct path to claim denials, delayed reimbursements, and costly administrative rework. Mastering the distinction between Excludes1 and

Master ICD-10 Excludes Notes: Prevent Costly Claim Denials Read More »

Prior Authorization Denials

Stop Prior Authorization Denials Permanently

Leave a Comment / July 2024

Prior authorization denials are one of the most frustrating and costly challenges facing practice managers, healthcare providers, and owners today. These preventable rejections create bottlenecks in your workflow, delay patient care, and directly impact your bottom line. But what if you could turn this administrative headache into a smooth, efficient process? The key is to

Stop Prior Authorization Denials Permanently Read More »