Contractual Denials

Tracing Problems that Can Trigger Coverage Denials

If you want to be sure payers consistently reimburse your organization in a timely and accurate manner, it’s important to comply with all contractual requirements – while making certain the payer does, too. Learn more about two major issues that can trigger contractual denials.

Coverage Denials

Tracing Problems that Can Trigger Coverage Denials

Insurance coverage issues that result in denials are a bit like electrical problems: If there is a faulty link or bad connection between the patient and payer, the circuit is broken, a denial is sparked and power–in this case, cashflow–is interrupted. Learn how to trace the provider-payer “wiring” early to ensure proper reimbursement.

Utilization Denials

Utilization Denials Take Many Forms

Who hasn’t experienced trying to buy something online, but the order locks up because some key piece of information is missing or wrong? Usually, the online interface will flag the data in question, so you can quickly make the change and submit your order. Unfortunately, this kind of automated safeguard doesn’t exist in most hospital billing systems when it comes to filing insurance claims.