Top 5 checklists to avoid Denials from Payers

Most experts are of the opinion that the minimum time it takes to receive the payment from an insurance payer should be at least 30 days. That’s why even small medical practices in the US aim for an average of below 30 days in AR. However, the benchmark set by the healthcare industry is around 50, and exceeding that number simply means that there are higher chances of claim denials. To make your payment collection efficient, you have to ensure that there are fewer claim denials.

Here are five top denial reasons that are easy to avoid and can enhance the cash flow for your healthcare practice:

1. Timely Filing

Different insurance payers maintain and follow the different deadlines for the claims submission that are specific to them. Most of them require you to file the claims within 90 days, 180 days, or a maximum of one year from the day of service. If you ensure the submission of completed claims every day, you can easily avoid the late fees and unnecessary denials. If your in-house team doesn’t have such ability, you must prioritize the claim forms by the amount and the deadline. For instance, bill the claims with a higher dollar value first and then concentrate on claims with an earlier deadline, such as 90-day filing.

Most insurance companies are stringent about their deadlines and will not consider claims beyond the set deadlines. That’s why it is worthy of paying overtime to ensure timely claims billing. Thereby, if your in-house billing team can’t handle all the claims timely, consider an outsourcing medical billing partner for the task.

2. Incorrect Patient Identifiers

Do you know that millions of claims get denied automatically by the front-end claims system every year? The simple reason behind such denials is incorrect or missing information of the patients, such as misspelling of the patient’s names, incorrect patient ID, and alike. Make sure to always ask for the most recent copy of a patient’s insurance card for verifying the ID and group numbers correctly. Moreover, take out the print of the information received verbally and get it checked from the patients for accuracy. Pay attention to every minute detail of the patient information that may affect the claims processing.

3. No Benefits or Coverage

When a service is not covered by the insurance policy, you will definitely receive a no-benefit denial from the payers. It can also happen if the patient’s coverage has lapsed or the providers are not within a network. To avoid such denials, you should conduct an insurance verification right on the day the service is rendered. Call up the verification number or use the online verification mode before providing the service.

4. Duplicate Claim

Whether your practice is just heavy-handed with the button of resubmission or working with inaccurate records, repeatedly re-billing the claims is very likely to result in several denials. In most cases, managed care contracts might drop the providers who undertake this repeatedly. If you are not receiving your claims payment timely, it highlights some issues in your billing procedures that need to be tackled as soon as possible. Moreover, resubmission of these denied claims is not an appropriate solution to these problems. In fact, you should opt for a resubmission only after having the words with the insurance payers and verify the details carefully to re-submit it without any further mistake.

5. Claim Lacks Information

Undoubtedly, certain denials require in-depth research to know the causes, along with the submission of certain medical certifications and records. But simultaneously, many denials arise due to a lack of information in the form of minor data mistakes. Leaving off a gender, date of birth, or other required secondary diagnoses code fall under the category of denial for information. To combat such denials, the best way out is to train your staff to ensure the duly review of every claim before they are actually submitted. You can also invest in updated billing software that validates a claim and informs the billers about the missing information before the final submission.


To enhance your cash flow significantly, one of the best ways is to prevent claim denials. Providing the training to the staff, paying attention to every detail, and following up on a timely billing process can keep you from losing the claim payments that you deserve to receive. If you want to learn more about how outsourced medical claims billing can improve your cash flow, get in touch with 24/7 Medical Billing Services today.

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