6 Common Claim Denials and How to Avoid Them

Managing claim denials is a crucial part of revenue cycle management for healthcare practices. When claims are denied, it can cause delays in payments, disrupt cash flow, and increase administrative workload. Understanding the common causes of claim denials and how to prevent them can significantly improve your practice’s financial health. Here are six of the most frequent claim denials and strategies to avoid them.

1. Claim Filed After the Timely Filing Deadline

Insurance companies have strict deadlines for submitting claims—typically within 90 days of the service date. Missing these deadlines results in an automatic denial with the code CO29.

How to Avoid It:

• Verify each payer’s filing deadline.
• Implement automated reminders to track submission timelines.
• Resubmit denied claims promptly within the appeal window.

2. Insurance Company Lost the Claim

Claims can sometimes get lost due to system errors, mailing issues, or miscommunication. If the lost claim isn’t resubmitted before the filing deadline, it will be denied.

How to Avoid It:

• Use a reliable clearinghouse to track claims.
• Confirm receipt of claims with insurance companies.
• Maintain thorough records of submission confirmations.

3. Pre-existing Conditions

While the Affordable Care Act prohibits insurers from denying coverage for pre-existing conditions, older claims may still be affected. Claims denied for this reason are marked with CO15.

How to Avoid It:

• Verify patient eligibility before service.
• Educate patients on coverage limitations.
• If denied incorrectly, file an appeal with supporting documentation.

4. Policy Cancellation

If a patient’s insurance policy has been canceled due to missed payments or false information, the claim will be denied.

How to Avoid It:

• Confirm active insurance coverage before providing services.
• Inform patients about policy renewal and payment requirements.
• If a policy was wrongfully canceled, initiate an internal or external appeal.

5. Duplicate Claim Submission

A claim may be denied with CO8 if it contains identical information to a previously submitted claim.

How to Avoid It:

• Implement a claim tracking system to monitor submissions.
• Train billing staff on communication best practices.
• Regularly audit claims to identify and eliminate duplicates.

6. Missing Information

Approximately 15% of claim denials occur due to missing data, leading to a CO252 denial code.

How to Avoid It:

• Use a clearinghouse to detect incomplete claims before submission.
• Double-check required fields such as patient demographics, provider details, and CPT codes.
• Standardize data entry procedures to minimize errors.

Final Thoughts

Claim denials can be frustrating and time-consuming, but with proactive strategies, healthcare practices can reduce denials and improve their revenue cycle efficiency. By implementing claim tracking, verifying patient information, and ensuring timely submissions, you can minimize denials and maximize reimbursements.

For expert assistance in revenue cycle management and medical billing, contact Svast Healthcare Technologies.