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Top Reasons For Claim Denials
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- Duplicate claim/service
- Incorrect patient insurance identification number
- Incorrect CPT codes with failure to use modifier when valid
- Incorrect ICD-9-CM code with failure to use fourth or fifth digits when required
- ICD-9-CM code does not correspond with CPT code
- Service performed or treatment of the provider was not validated as a procedure that was medically necessary
- Failure to identify referring physician and the identification number
- Incorrect charges and total amounts that do not equal total charges
- Missing place-of-service code required for Medicare, Medicaid and CHAMPUS/VA and most commercial carriers
- Missing type-of-service code required for CHAMPUS/Tricare and some commercial carriers
- Incorrect, missing or duplicate dates of service
- Non-covered services because the payer does not deem this a "medical necessity"
- Charges denied/reduced because procedure/service was partially or fully furnished by another provider
- Claim/service denied/reduced because treatment was deemed by payer to have been rendered in an inappropriate or invalid place-of-service
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