Denial claim is a cliam which is not paid for some reason. Usually EOB itself clearly having the reason for denial which is called as denial codes. We need to find this denial codes and need to take the action accordingly.
The commone denial reason are given below.
1. Coverage Terminated
2. Invalid or Missing Provider Id# and NPI informations.
3. Invalid Procedure code
4. Invalid Diagnosis code
5. Invalid or missing modifier
6. Pre-existing Condition
7. Authorization number required or Invalid
8. Anesthesia time not on claim
9. Anesthesia Records / Op.Notes / Medical Necessity records required
10 . Exceeded the normal time for filing limit
11. Require W9 form
12. Incorrect Patient id#
13. Signature missing (in block 31 of HCFA)
14. ‘None’ required in slot 11 of HCFA
15. Employer’s name and address required
16. : Claim need to be sent to local plan.
17. : PIP benefits exhausted
18. Amount paid to the subscriber.
19. Claim needs to be submitted to w/c carrier / Employer.
20 : Requested information from patient
We could not list all the denials here. If you browse this website you can find the answer for most of the above denial.
